Search Results (2,133)

Large intracoronary thrombus burden during percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains technically challenging when conventional manual aspiration is ineffective or dedicated thrombectomy systems are unavailable, unsuitable, or undeliverable. Routine aspiration thrombectomy is not guideline-supported, but selective bail-out thrombus-removal strategies remain relevant in refractory thrombus-rich PCI. This contemporary narrative review, supplemented by six retrospective single-center clinical examples, describes off-label guide-extension catheter (GEC)-assisted thrombus aspiration and places it within the current thrombectomy landscape, including manual aspiration catheters, sustained mechanical aspiration platforms, and stent-retriever-based systems. The heterogeneous examples, predominantly involving the right coronary artery, are educational and hypothesis-generating only: they illustrate procedural mechanics, patient selection, technical pitfalls, and risk mitigation, but do not provide efficacy or safety evidence. GEC-assisted aspiration may be considered when bulky proximal thrombus cannot be captured by smaller catheters or when a GEC can be positioned coaxially near the thrombus face under uninterrupted negative pressure. The technique remains operator-dependent, off-label, and anatomically constrained and should be regarded as a contingency maneuver rather than an alternative to purpose-built systems with more formal device-specific evaluation. Prospective registries and comparative studies are required before efficacy, safety, or relative value can be established. Full article

Background. Cardiometabolic diseases are the leading cause of morbidity and mortality worldwide and are driven by risk factors such as hypertension, diabetes mellitus, and dyslipidemia. Early vascular aging (EVA) is a pathological process characterized by accelerated arterial stiffness and endothelial dysfunction, which increase the risk of cardiovascular events. Key markers of EVA include advanced glycation end products (AGEs), aortic pulse wave velocity (a-PWV), glycated hemoglobin A1c (HbA1c) and pulse pressure (PP). Although these markers are individually associated with cardiovascular outcomes, there is still limited evidence from longitudinal studies evaluating their combined association with cardiometabolic diseases and hypertension, particularly with consideration of gender differences. Therefore, in this study, data from the two-year EVasCu cohort were used to analyze the associations between EVA and cardiometabolic diseases and hypertension; the associations between EVA related parameters (AGEs, a-PWV, HbA1c and PP) were evaluated, and these associations were assessed by gender. Methods. AGE, a-PWV, HbA1c and PP were measured as indicators of EVA, in addition to sociodemographic and clinical variables. Logistic regression was applied to assess the association between EVA and cardiometabolic diseases (including hypertension, diabetes mellitus, acute myocardial infarction (AMI), dyslipidemia, angina pectoris, and heart failure (HF)) and hypertension, adjusting for age, gender and risk factors. Results. A 2-year longitudinal study was conducted with 200 adults in Cuenca, Spain. EVA was significantly associated with the development of cardiometabolic diseases (OR = 1.38; p = 0.028) and hypertension (OR = 1.63; p = 0.015), which was more pronounced in females. Cardiometabolic diseases and hypertension were associated with a-PWV and PP, but not with AGEs or HbA1c. Conclusions. a-PWV and PP are predictors of cardiometabolic diseases and hypertension, especially in females. Early detection and preventive strategies are essential for detecting cardiovascular risk and mitigating consequences. Further studies are needed to investigate the relationships between EVA and cardiometabolic factors. Full article

Most patients with chest pain do not have acute myocardial infarction (AMI), yet post-AMI rule-out disposition remains variable. Detectable but sub-99th percentile high-sensitivity cardiac troponin I (hs-cTnI) provides additional prognostic information. We evaluated the economic value of hs-cTnI-guided hospitalizations among non-AMI patients. We analyzed 1481 non-AMI chest pain visits with detectable baseline hs-cTnI across 29 U.S. emergency departments (2014–2016) in the prospective HIGH-US trial using the Atellica IM TnIH assay(Siemens Healthcare Diagnostics, Tarrytown, NY, US). We compared observed standard-of-care admissions with modeled pathways incorporating hs-cTnI thresholds and risk scores, assessing admission rates, costs, and diagnostic accuracy for 30-day death/MI. Overall, 1.0% (n = 15/1481) experienced 30-day death/MI. Standard-of-care admitted 59% of patients with 93% sensitivity and 41% specificity. The modeled pathway using hs-cTnI ≥ 5 ng/L plus non-low risk scores was associated with reduced projected admission of 41%, higher specificity of 60%, and the same 93% sensitivity. Estimated per-patient diagnostic costs were lower under Scenario 1 (noninvasive diagnostic testing only; $1025 vs. $1139) and under Scenario 2 (including inpatient/invasive procedures; $2672 vs. $3536). In subgroups, higher hs-cTnI thresholds conferred further economic benefit without compromising sensitivity. Incorporating sub-99th percentile hs-cTnI thresholds alongside risk scores may support more efficient resource use while maintaining safety, although findings require prospective validation. Full article

Percutaneous coronary intervention (PCI) using drug-coated balloons (DCBs) may provide outcomes comparable to drug-eluting stents (DESs) due to the absence of a permanent implant and improved coronary artery remodelling. This study compared clinical outcomes of DCB-only angioplasty with DESs in a real-world setting. All patients undergoing PCI with DCBs or DESs for de novo disease were included in a propensity score-matched analysis using prospective and retrospective collected data from a single centre. The primary outcome was target lesion revascularisation (TLR) at 12 months. The secondary outcomes were major adverse cardiac events (MACEs) defined as a composite of all-cause death, myocardial infarction, or TLR at 12 months. Propensity matching produced 904 DCB lesions (719 patients) matched to 1424 DES lesions (1271 patients). The DCB group had smaller coronary arteries, shorter treated segments, and more bifurcation lesions. The mean age was 65 years, 22% of patients had prior MI, 16% had diabetes, and 58% had acute coronary syndromes. The rate of TLR at 12 months was as follows: 2.3% with DCBs; 2.5% with DESs (OR 0.86, p = 0.726, 95% CI 0.37–2.02). MACE was 8.2% with DCBs and 7.3% for DESs (OR 1.04, 95% CI 0.73–1.47). Results suggest comparable outcomes in patients who received paclitaxel DCBs compared to DESs without excess MACE, highlighting the need for randomised controlled trials. Full article

Background: Clinical lipidomics can capture disease-associated molecular alterations at high resolution, yet translating complex lipid species data into interpretable biological insight remains challenging. Existing workflows often emphasize statistical discrimination while underutilizing the structural information embedded in lipid species. To address this gap, we developed LipiDecipher, a structure-oriented analytical framework designed to summarize lipidomic alterations into interpretable structural patterns and to provide database-supported biological contextualization. Methods: LipiDecipher integrates differential lipid analysis, structure-resolved summarization, multivariate discrimination, and knowledge-based lipid-to-protein/pathway contextualization. We applied this framework to a retrospective serum lipidomics dataset comprising healthy controls and patients with acute myocardial infarction or post-PCI recurrent myocardial infarction. To improve transparency and robustness, the revised analysis includes sex-disaggregated reporting, covariate-adjusted sensitivity analyses for sex and age, and internal separation stability assessment of category-specific LDA projections through resampling-based feature stability analysis, repeated cross-validation, and permutation testing. Results: The framework identified distinct lipid alterations across study groups, including changes in phosphatidylinositols, ceramides, and triglyceride remodeling patterns. These alterations became more interpretable when summarized at the structural level, including lipid class composition, acyl-chain length, and degree of unsaturation. Internal discrimination analyses suggested separability between groups, while repeated resampling highlighted a subset of recurrently selected lipid features. Knowledge-based mapping prioritized lipid-associated biological contexts related to glycerophospholipid metabolism, sphingolipid metabolism, membrane remodeling, inflammatory signaling, and energy-related processes. Importantly, these protein- and pathway-level outputs are presented as database-supported hypotheses rather than direct evidence of target engagement or pathway activation in the studied cohort. Conclusions: LipiDecipher provides a structure-oriented and interpretation-focused framework for clinical lipidomics. In a retrospective acute myocardial infarction cohort, it enabled the prioritization of candidate lipid signatures and biologically plausible hypotheses from complex lipidomic data. These findings support its use as a hypothesis-generating analytical tool, while external validation and experimental follow-up remain necessary before mechanistic or clinical claims can be established. 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/Objectives: Intensive care unit (ICU) mortality reflects interactions between baseline vulnerability, acute physiological derangement, ICU-acquired infection, and the intensity of organ-support therapy. Methods: This single-center retrospective cohort study included 3323 adult first ICU hospitalizations at the University Clinical Hospital in Bialystok, Poland, between 1 January 2017 and 1 June 2023. Secondary ICU admissions/readmissions, patients aged <18 years, and one pregnancy admission were excluded. Patients were classified as ICU survivors (n = 1778) or ICU non-survivors (n = 1545). Variables were compared using t-tests, chi-square tests, or Fisher exact tests, and an adjusted logistic regression model was fitted as an exploratory prognostic model. Results: ICU mortality was 46.5%, and 28-day ICU mortality was 40.2%. Non-survivors were older than survivors (66.7 ± 15.1 vs. 60.9 ± 17.2 years; p < 0.001) and more frequently had arterial hypertension, diabetes mellitus, COVID-19, ischemic heart disease, atrial fibrillation, renal failure, and acute myocardial infarction or ischemic stroke. In the adjusted model, ICU mortality was associated with age per 10 years (OR 1.32, 95% CI 1.18–1.47), COVID-19 (OR 3.15, 95% CI 2.07–4.79), ventilator-associated pneumonia (OR 1.68, 95% CI 1.22–2.30), lactate per 1 mmol/L (OR 1.29, 95% CI 1.16–1.43), pH per 0.1-unit decrease (OR 1.79, 95% CI 1.41–2.29), mechanical ventilation (OR 14.74, 95% CI 3.40–63.87), cardiopulmonary resuscitation (OR 9.45, 95% CI 4.67–19.13), renal replacement therapy (OR 2.01, 95% CI 1.39–2.91), and treatment of acidosis or alkalosis (OR 1.95, 95% CI 1.29–2.94). Conclusions: ICU non-survival was associated with older age, COVID-19, cardiovascular and renal vulnerability, ICU-acquired infection, inflammatory and metabolic dysfunction, and early requirement for rescue organ-support interventions. These findings should be interpreted as adjusted associations, not causal effects. Full article

Background: Micro- and nanoplastics (MNPs) are emerging contaminants increasingly detected in human tissues and biological fluids. Their presence in blood, vascular tissues, thrombi, and atherosclerotic plaques raises concern about their possible association with cardiovascular disease. This systematic review synthesized evidence on associations between MNPs and cardiovascular pathology. Methods: A systematic search was conducted in October 2025 in PubMed, Scopus, Web of Science, and Embase according to PRISMA guidelines and a PICOS-based strategy. Original human studies from the last 10 years were eligible. Fourteen studies were included. Due to methodological heterogeneity, a narrative synthesis was performed. Risk of bias was assessed using ROBINS-E, and certainty of evidence was evaluated using a GRADE-informed approach. Results: MNPs were detected in multiple cardiovascular-related matrices. Included studies suggested possible associations with major adverse cardiovascular events, acute coronary syndrome, myocardial infarction, arterial stenosis, vascular calcification, thromboembolic disease, hypertension, inflammatory markers, coagulation-related parameters, and lipid profiles. However, the certainty of evidence was very low, and most studies had a high or very high risk of bias. Conclusions: Current evidence suggests a possible association between MNPs and cardiovascular pathology, but causality remains unproven. Larger prospective studies using standardized detection protocols, rigorous contamination control, and adjustment for confounders are needed. 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

Little is known regarding in-hospital transthoracic echocardiography (TTE) utilization and its prognostic implications among stable patients with acute myocardial infarction (AMI). We aimed to explore patient and disease characteristics, treatment strategies, and mid-term outcome following uncomplicated AMI according to TTE use during the hospitalization phase. A single-center, retrospective analysis was conducted that included consecutive adult individuals admitted for AMI who did not develop cardiogenic shock and who survived the index hospitalization. Stratified by in-hospital TTE administration status, the cohort was evaluated for all-cause mortality at 1-year post-discharge. Overall, 15,971 subjects (mean age 66 ± 14 years, 69.8% males, 46.1% with ST-elevation myocardial infarction) were analyzed, of whom 12,610 (79.0%) underwent TTE. TTE use correlated with younger age, fewer comorbidities, greater odds of invasive revascularization and intensive coronary care unit management, and lengthier hospital stay. Ultimately, it was associated with a lower rate, cumulative incidence, and—independent of accompanying prognostic markers—risk of all-cause mortality (n = 1032/12,619, 8.2% vs. n = 804/3361, 23.9%, p < 0.001; Log-Rank p < 0.001; adjusted hazard ratio 0.75, 95% confidence interval 0.67–0.83, p < 0.001). Similar results were observed within a 6270-patient, 1-1 propensity score-matched sub-cohort. To conclude, in our experience, in-hospital TTE administered for stable AMI patients was associated with improved mid-term survival. Further research is needed to re-evaluate the present-day recommendation’s Level of Evidence C for its routine use. Full article

Seasonal influenza is not only a respiratory infection but also a clinically relevant trigger of acute cardiovascular events. In adults with established cardiovascular disease, particularly older adults and patients with recent acute coronary syndrome or heart failure, influenza vaccination should be considered a low-risk, evidence-supported component of cardiovascular prevention rather than solely protection against respiratory disease. The evidence addresses three related but distinct questions: influenza infection as a cardiovascular trigger; influenza vaccination versus placebo or no vaccination; and enhanced or high-dose vaccination versus standard-dose vaccination. Randomized trials and meta-analyses support reductions in major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality in higher-risk secondary-prevention populations, with particularly persuasive evidence after myocardial infarction. Recent pragmatic active-comparator trials of high-dose inactivated influenza vaccine, including DANFLU-2 and GALFLU, and the individual-level pooled FLUNITY-HD analysis provide incremental evidence in adults aged 65 years or older, strongest for hospitalization for influenza or pneumonia, cardiorespiratory hospitalization, and heart failure hospitalization. The current priority is implementation: screening, offering, documenting, and communicating vaccination across hospitalization, outpatient cardiology, cardiac rehabilitation, heart failure pathways, primary care, pharmacies, and long-term care. Influenza vaccination should complement, not replace, established guideline-directed cardiovascular therapies. Full article

Background and Objective: Romosozumab carries a warning for potential severe cardiovascular events, while denosumab is widely used for osteoporosis but requires safety considerations in advanced chronic kidney disease (CKD). Given the limited direct real-world evidence comparing these treatments, in this study, we aimed to compare the cardiovascular and survival outcomes associated with romosozumab versus denosumab in adults with CKD. Materials and Methods: In this retrospective propensity score-matched cohort study, we utilized de-identified electronic health records from the TriNetX Global Collaborative Network, where eligible participants were adults aged 40 to 90 years with CKD who initiated either romosozumab or denosumab. Patients with bone/bone marrow malignancies or recent acute cardiovascular events were excluded. Following 1:1 propensity score matching based on demographics, diagnoses, medications, and laboratory characteristics, patients were followed for up to 1095 days. The primary outcome was a composite cardiovascular measure (all-cause mortality, acute myocardial infarction, or cerebrovascular event), while secondary outcomes included the individual components of the composite outcome and acute heart failure. Outcomes were evaluated using fixed-window cumulative risks, risk ratios (RRs), odds ratios, and hazard-ratio estimates. Results: After 1:1 propensity score matching, 1201 patients remained in each cohort; the mean age was 74.1 years in the romosozumab cohort and 74.2 years in the denosumab cohort, and 94.9% and 93.8%, respectively, were women. Romosozumab was associated with lower 1095-day cumulative risk of the composite cardiovascular outcome than denosumab (12.6% vs. 18.8%; RR, 0.668 [95% CI, 0.553–0.808]), as well as lower cumulative risk of cerebrovascular event (5.0% vs. 7.0%; RR, 0.714 [95% CI, 0.518–0.985]), all-cause mortality (6.6% vs. 9.5%; RR, 0.693 [95% CI, 0.526–0.913]), acute myocardial infarction (3.8% vs. 6.2%; RR, 0.613 [95% CI, 0.429–0.878]), and heart failure (2.7% vs. 6.1%; RR, 0.438 [95% CI, 0.292–0.659]). Conclusions: In this propensity score-matched EHR cohort of adults with CKD, cardiovascular and survival estimates associated with romosozumab versus denosumab varied by follow-up window and analytic approach. Although 1095-day fixed-window cumulative risks were lower in the romosozumab cohort, corresponding time-to-event estimates were neutral or directionally inconsistent. These findings should not be interpreted as evidence of cardioprotection or causal superiority but rather as showing no clear and consistent excess cardiovascular risk signal for romosozumab compared with denosumab. Full article

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 purpose of the study is the assessment of mortality from cardiovascular diseases (CVDs) and their dose–response relationships and the calculation of the number of years of life lost (YLL) in Kazakhstani residents living in territories around the Semipalatinsk nuclear test site. Materials and Methods: The study is based on the State Scientific Automated Medical Registry (SSAMR) database. The study included 3482 residents of the Abay and Beskaragai districts exposed to radiation and 1886 residents of the Kokpekty district (control group). The median equivalent radiation dose for the exposed group was 864.0 mSv, compared to 64.4 mSv in the control group. The study period was from 1949 to 2024. Results: Mortality rates in the exposed group exceeded those of the comparison group throughout the study. The relative risk (RR) of mortality was 1.41 for all CVDs, 2.0 for stroke, 7.88 for chronic cerebrovascular disease (CCVD), and 2.39 for congenital heart disease (CHD). Age-standardized mortality rates were higher in the radiation-exposed population, with the highest excess risk recorded in 1960–1964 (RR = 5.31; 95% CI 4.32–6.53). The number of YLL from acute myocardial infarction (AMI) was 6097.0 in the exposed group versus 5893.0 in the comparison group, 3857.5 from hemorrhagic stroke versus 1996.9, and 2696.6 from CHD versus 957.7. An increase in radiation dose by 1 cSv was associated with an 8.5% increase in the odds of death from CVDs (OR = 1.085; 95% CI 1.075–1.094; p < 0.001). Radiation dose demonstrated good predictive ability for mortality from cardiovascular diseases (AUC = 0.700). Conclusions: The results indicate an increased risk of CVD mortality among residents of radiation-contaminated areas of Kazakhstan throughout the study period. Full article

There have been considerable developments in the analytic precision of cardiac troponins in the last three decades. Whilst there has been near-universal uptake of this technology, there is considerable variability in how to assess acute chest pain patients using high-sensitivity cardiac troponins. This review describes the historical narrative for cardiac troponins and details the evidence base behind decision rules, such as single sample rule-out, single sample rule-in, and accelerated diagnostic protocols (ADPs). There is particular focus on the European Society of Cardiology (ESC) 0/1 and 0/3 h and the high-STEACS ADPs. The ESC 0/3 h ADP appears to have reduced rule-out safety compared to both the ESC 0/1 h and high-STEACS ADP. However, whilst high-STEACS performed well in its validation population, external validation in the US has been less impressive and warrants further investigation. The ESC 0/1 h pathway has demonstrated strong rule-out performance, helped by its observational zone. However, real world implementation studies comparing these ADPs are required to understand their impact on Emergency Department efficiency and the safety of clinician decision-making. Full article