Search Results (354)

Patients with chronic liver disease are systematically excluded from acute myocardial infarction (AMI) trials, and prior real-world data rely on administrative coding alone. Whether ICD-coded liver disease and laboratory-defined liver fibrosis identify the same patients, and whether they predict the same outcomes, is unknown. We conducted a single-center retrospective cohort study of 1037 consecutive adults admitted with AMI (ICD-10 I21.x) to a tertiary New York center between November 2022 and December 2024. The primary exposure was ICD-defined advanced liver disease (cirrhosis, hepatic failure, or portal hypertension/decompensation; n = 102). The secondary, lab-based exposure was the Fibrosis-4 (FIB-4) index calculated from earliest admission AST, ALT, and platelet count (computable in 1031 patients, 99.4%), stratified as low (<1.45), indeterminate (1.45–3.25), or advanced (>3.25). Co-primary outcomes were invasive management (diagnostic angiography, percutaneous coronary intervention, or coronary artery bypass grafting) and in-hospital mortality. Multivariable logistic regression adjusted for age, sex, diabetes, chronic kidney disease, heart failure, and ST-elevation; the trend across FIB-4 tiers was assessed with the Cochran–Armitage test. Denominators throughout (including the 168/909 occult-fibrosis estimate) use the full exposure group as denominator under a missing-as-not-exposed convention; the four no-LD and two advanced-LD patients with missing FIB-4 are counted as non-advanced fibrosis for this calculation. Patients with ICD-defined advanced liver disease received invasive management less often (12.7% vs. 50.4%; adjusted odds ratio [aOR] 0.17, 95% CI 0.09–0.32) and died in hospital more often (43.1% vs. 7.9%; aOR 8.22, 95% CI 5.02–13.46) than patients without coded liver disease. Outcomes worsened monotonically across FIB-4 tiers (mortality 4.4% → 9.2% → 27.5%; invasive management 55.2% → 45.6% → 33.5%; both p < 0.001 by Cochran–Armitage trend test). Critically, 168 of 909 patients with no coded liver disease (18.5%) had FIB-4 > 3.25, representing a substantial population of unrecognized advanced fibrosis missed by clinical coding. Coded liver disease identifies a small, severely affected subgroup with markedly lower rates of invasive management and 6- to 8-fold higher mortality after AMI. Routine FIB-4 calculation, a free, three-variable lab score, identifies a much larger population with occult advanced fibrosis and graded excess risk that ICD codes miss entirely. Pending prospective validation, FIB-4 may serve as a low-cost adjunct to bedside risk stratification in AMI care. Full article

A 66-year-old man with hypertension, type 2 diabetes mellitus, and a 50-year smoking history was presented with acute chest pain clinically consistent with unstable angina. Coronary computed tomography angiography (CCTA) showed multivessel atherosclerosis and, more strikingly, diffuse sheath-like pericoronary soft-tissue cuffing around the major epicardial arteries—an appearance reported as the “mistletoe sign” and compatible with immunoglobulin G4 (IgG4)-related coronary periarteritis. CT-derived fractional flow reserve (CT-FFR) measured 0.75 in the left anterior descending artery, 0.68 in the left circumflex artery, and 0.94 in the right coronary artery. Invasive angiography identified a 90% proximal left circumflex stenosis as the flow-limiting lesion; drug-eluting stent implantation restored Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. Serum IgG4 (145 mg/dL) was only marginally above the diagnostic threshold, and troponin was unavailable, so the diagnosis remained clinical. Without histopathology, the findings support possible rather than definite IgG4-related disease, and the contribution of the pericoronary process to the stenosis could not be established. The patient remained stable on conventional medical therapy. CCTA, CT-FFR, and angiography answer complementary questions; diffuse pericoronary change warrants serologic and systemic evaluation for inflammatory coronary involvement, with cautious etiologic attribution. Full article

Coronary slow flow (CSF) is delayed distal contrast transit on angiography without flow-limiting stenosis; disturbed sleep may impair vascular control through autonomic, endothelial, inflammatory, and metabolic pathways. We evaluated Pittsburgh Sleep Quality Index (PSQI)-based sleep quality in relation to TIMI frame count (TFC)-defined CSF. This cross-sectional study enrolled 307 adults with nonobstructive coronary arteries undergoing angiography for chest pain; PSQI referenced the preceding month, and CSF was defined by corrected TFC > 27 frames in any major vessel; 132 participants had CSF and 175 normal flow. Global PSQI score was higher in CSF (median 7.0 vs. 5.0) and poor sleep quality (score > 5) was more frequent (75.8% vs. 49.7%; both p < 0.001). The global score correlated with mean TFC overall but not within flow groups. Each PSQI point independently raised CSF odds, including after STOP-Bang adjustment, although discrimination was modest. Sleep latency and short duration raised CSF odds; poor efficiency did not. Poorer sleep quality was independently linked to this angiographic slow-flow phenotype, mainly differentiating flow categories rather than tracking frame-count burden. Because coronary microvascular function was not measured directly, these hypothesis-generating findings should prompt systematic sleep assessment and prospective studies integrating objective sleep measures with invasive coronary physiology. Full article

Type 2 myocardial infarction (T2MI) occurs secondary to an imbalance between myocardial oxygen supply and demand, with systemic conditions serving as the primary precipitating factors. T2MI predominantly affects older adults and is frequently accompanied by multiple chronic comorbidities. Therefore, it often has an atypical clinical course and remains a significant diagnostic and therapeutic challenge, particularly given the lack of standardized clinical guidelines. Furthermore, the diagnosis of T2MI in women is especially challenging due to sex-related differences in biomarker kinetics and atypical symptom presentation. The aim of this review is to summarize current knowledge on T2MI, discuss modern diagnostic tools, and analyze sex-related differences in this context in order to identify future directions for the development of therapeutic guidelines. The review emphasizes the need for a multimodal approach, integrating biomarkers, individualized clinical decision-making and advanced cardiac imaging, as differentiation between T2MI and T1MI remains a significant challenge. Therefore, both non-invasive and invasive diagnostic strategies may be required to accurately identify patients with T2MI. Although routine coronary angiography in T2MI is not clearly supported by current evidence, it may be useful as a decisive tool for reclassification, particularly when the clinical presentation is ambiguous. Full article

Background and Objectives: Identification of obstructive coronary artery disease (CAD) in patients presenting with a dilated cardiomyopathy phenotype is clinically important because it may influence etiologic classification, prognosis, and subsequent management. However, real-world angiography-based data on the prevalence and angiographic severity of obstructive CAD in this setting remain limited, particularly in regional single-center cohorts. Materials and Methods: This retrospective single-center cohort study included consecutive patients presenting with a newly diagnosed dilated cardiomyopathy (DCM) phenotype of initially unknown etiology who underwent first-time diagnostic invasive coronary angiography at St. Marina University Hospital, Varna, Bulgaria, between January 2010 and December 2025. Obstructive CAD was defined as stenosis >70% in a major epicardial coronary artery with a reference vessel diameter >2.5 mm. Patients were categorized as having non-obstructive or no significant coronary stenoses, single-vessel disease, two-vessel disease, or three-vessel disease. Additional descriptive analysis assessed severe occlusive coronary lesions, defined as chronic total occlusions or subtotal stenoses. The primary endpoint was the prevalence of obstructive CAD. Secondary analyses included angiographic disease extent, vessel-level coronary involvement, severe occlusive lesions, and coronary revascularization. Results: A total of 107 patients were included. Mean age was 55.4 ± 10.9 years, and 97 patients (90.7%) were male. Obstructive CAD was identified in 19 patients (17.8%; 95% confidence interval [CI], 11.7–26.1%), whereas 88 patients (82.2%) had non-obstructive or no significant coronary stenoses. Among patients with obstructive CAD, 3 (15.8%) had single-vessel disease, 4 (21.1%) had two-vessel disease, and 12 (63.2%) had three-vessel disease. Severe occlusive coronary lesions were present in 10 of 19 patients (52.6%); 8 (42.1%) had at least one chronic total occlusion and 5 (26.3%) had at least one subtotal stenosis. Conclusions: In this retrospective single-center cohort of patients presenting with a dilated cardiomyopathy phenotype and referred for coronary angiography, obstructive CAD was present in fewer than one in five patients. In contrast, most had non-obstructive or no significant epicardial coronary stenoses. However, when obstructive CAD was present, three-vessel disease and severe occlusive lesions were frequent. These findings indicate that obstructive epicardial CAD was uncommon in this selected angiography-referred cohort while underscoring the clinical role of coronary angiography when an ischemic or mixed etiology is clinically suspected. Full article

Kounis syndrome (KS) is a largely underdiagnosed cause of acute coronary syndromes triggered by allergic or hypersensitivity reactions. The syndrome results from complex immune cell activation with the release of vasoactive and prothrombotic mediators leading to coronary vasospasm (type I KS) or thrombosis of plaque (type II KS), stent (type III KS) or coronary artery bypass graft (type IV KS). Despite increasing recognition over the past few decades, its pathophysiological mechanisms, diagnostic boundaries, and therapeutic implications remain incompletely understood. A comprehensive diagnostic approach, including signs, symptoms, biochemical findings, electrocardiography, echocardiography, coronary angiography, and multimodality imaging, as well as invasive assessment in selected cases, can be recommended, although its implementation in routine practice remains limited. Available data indicate that angiographically documented epicardial coronary spasm is observed in only a minority of patients, while normal or non-obstructive coronary arteries are frequently encountered. Emerging data from provocative testing, invasive coronary functional assessment, cardiac magnetic resonance and nuclear imaging suggests that coronary microvascular dysfunction may contribute substantially to the clinical phenotype, expanding the traditional concept of allergic epicardial vasospasm. Current evidence supports the recognition of type I KS as a distinct allergic vasomotor acute coronary syndrome within the myocardial infarction non-obstructive coronary artery (MINOCA) spectrum, deserving greater recognition in future diagnostic classifications and clinical practice guidelines. This narrative review critically appraises current evidence, integrating historical perspectives with contemporary insights into classification, pathophysiology, triggers, diagnostic strategies and therapeutic approaches, focusing on the most frequent manifestation represented by the vasospastic variant. Full article

Background/Objectives: Obesity and diabetes mellitus coexist, but the association of obesity with invasive management and in-hospital outcomes in acute myocardial infarction (AMI) complicated by cardiogenic shock is uncertain. We evaluated these associations among adults with diabetes mellitus. Methods: We performed a retrospective discharge-level analysis of the National Inpatient Sample for 2016–2021. Obesity was identified from ICD-10-CM codes. Survey-design logistic regression accounted for weights, strata, hospital clusters, and prespecified covariates. Results: The cohort comprised 19,399 discharges, representing 96,995 hospitalizations; 24.1% had obesity. Angiography and coronary artery bypass grafting (CABG) were more frequent with obesity, whereas percutaneous coronary intervention (PCI) was less frequent. After adjustment, obesity was associated with higher odds of angiography (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.03–1.21) and CABG (aOR 1.49, 95% CI 1.35–1.63), lower odds of PCI (aOR 0.90, 95% CI 0.84–0.97), and similar odds of circulatory support (aOR 1.00, 95% CI 0.93–1.07). Adjusted odds were lower for major adverse cardiovascular and cerebrovascular events (aOR 0.88, 95% CI 0.82–0.95), in-hospital mortality (aOR 0.90, 95% CI 0.83–0.98), acute ischemic stroke (aOR 0.78, 95% CI 0.64–0.95), and major bleeding (aOR 0.86, 95% CI 0.76–0.98). Procedure adjustment attenuated mortality and major bleeding. Conclusions: Obesity was associated with a different invasive-management pattern and lower adjusted odds of several short-term outcomes, consistent with an apparent in-hospital obesity paradox in this high-risk population. Full article

Background and Objectives: Coronary artery disease may be difficult to detect by resting echocardiography when left ventricular ejection fraction is preserved and regional wall motion abnormalities are absent. This study aimed to assess whether resting Tissue Doppler Imaging-derived mitral annular velocities can help identify CAD in patients with suspected angina pectoris. Materials and Methods: We conducted a cross-sectional observational study of 92 patients hospitalized with suspected angina pectoris who underwent elective coronary angiography at the Institute of Cardiovascular Diseases in Timișoara (January 2025–February 2026). Patients with conditions known to affect TDI-derived parameters were excluded, including previous acute coronary syndrome or myocardial revascularization, significant valvular disease, cardiomyopathies, relevant arrhythmias or conduction abnormalities, permanent pacing, reduced ejection fraction, and pericardial disease. Laboratory and echocardiographic data were collected. ROC curve analysis, univariable logistic regression and multivariable logistic regression were performed to evaluate the diagnostic performance of TDI-derived parameters and their independent association with coronary artery disease. Results: Patients with CAD had significantly lower average E′ values (7.4 ± 1.9 vs. 8.9 ± 1.8 cm/s, p < 0.001) and average S′ values [7.0 (IQR 6.0–7.5) vs. 9.0 (IQR 8.1–10.0) cm/s, p < 0.001], together with higher E/E′ ratios [9.33 (IQR 8.23–11.15) vs. 7.87 (IQR 5.93–9.51), p = 0.002]. Average S′ showed the highest discriminative ability for coronary artery disease, with an AUC of 0.899 (95% CI: 0.819–0.952, p < 0.0001). The optimal Youden-derived cut-off was ≤7.5 cm/s, yielding 77.42% sensitivity and 93.33% specificity. After adjustment for age, male sex, body mass index, diabetes, smoking status, hypertension and LVEF, dichotomized S′ remained an independent predictor of coronary artery disease (OR = 45.49, 95% CI: 8.03–257.68, p < 0.0001), with an adjusted model AUC of 0.92 and 88.04% correct classification. Conclusions: TDI, particularly S′ velocity, may be a useful resting echocardiographic parameter for identifying CAD in selected patients with preserved LVEF and no resting regional wall motion abnormalities. Rather than serving as a universal diagnostic marker, S′ should be considered a complementary, easily obtainable parameter that may improve non-invasive assessment in this specific clinical setting. Full article

Background and Objectives: Coronary computed tomography angiography (CCTA) has become a central non-invasive imaging modality for the evaluation of suspected chronic coronary syndromes. Nevertheless, referral patterns and sex-related differences in real-world CCTA utilization may vary according to demographic structure, healthcare accessibility, and regional clinical practice. The present study aimed to evaluate age- and sex-related patterns in CCTA referrals and coronary atherosclerotic burden within a real-world Eastern European single-center CCTA referral cohort. Materials and Methods: We performed a retrospective analysis of 2742 consecutive CCTA examinations at a tertiary center in Sibiu, Romania, between March 2019 and January 2025. The demographic profile of the referral cohort was compared with the adult population structure of Sibiu County. Subsequently, an age- and sex-stratified proportional subsample of 397 cases was selected from the CCTA cohort for detailed analysis of sex-related differences regarding coronary artery calcium score (CACS), significant coronary stenoses, and significant cardiovascular event risk. Results: The age distribution of the CCTA referral cohort differed significantly from that of the adult county population (p < 0.01), with referrals concentrated predominantly between 55 and 79 years of age. Female patients were overall more frequently represented within the referral cohort compared with the underlying county population; however, males demonstrated significantly higher coronary artery calcium scores, a greater prevalence of significant coronary stenoses, and higher revascularization risk compared with females—particularly between 50 and 79 years of age—within the stratified proportional subsample. In contrast, patients younger than 40 years demonstrated very low rates of significant coronary disease regardless of sex. Conclusions: This study provides a real-world perspective on age- and sex-related patterns in CCTA utilization and coronary atherosclerotic burden within an Eastern European imaging center. The findings highlight the interaction between demographic structure, guideline-directed diagnostic strategies, and coronary imaging utilization in routine clinical practice. Full article

Background: Non-invasive biomarkers may facilitate early risk stratification in patients with coronary artery disease (CAD). Although the uric acid-to-HDL cholesterol ratio (UHR) has been identified as a novel marker associated with coronary atherosclerosis, the relationship between the uric acid-to-magnesium ratio (UA/Mg ratio) and the angiographic burden of coronary artery disease has not been sufficiently investigated. This study evaluated the association between the UA/Mg ratio and angiographic coronary artery disease burden in patients undergoing elective coronary angiography and compared its discriminative performance with that of the UHR and the frontal QRS-T angle. Methods: In this retrospective cross-sectional study, patients who underwent elective coronary angiography between 2022 and 2025 were evaluated. Patients with atrial fibrillation, left ventricular ejection fraction <50%, eGFR < 50 mL/min/1.73 m², severe valvular disease, uric acid-lowering therapy, or acute coronary syndrome were excluded. A total of 351 patients were included in the study and divided into three groups—low (n = 117), intermediate (n = 117), and high (n = 117)—based on their Gensini scores. Independent associations were evaluated using multivariable ordinal logistic regression analysis. Receiver operating characteristic (ROC) analysis was performed to evaluate discrimination of the high Gensini tertile. Results: The UA/Mg ratio was strongly correlated with the Gensini score (ρ = 0.699, p < 0.001), showing a correlation comparable to that of the UHR (ρ = 0.717, p < 0.001) and stronger than that of the frontal QRS-T angle (ρ = 0.546, p < 0.001). In the multivariable ordinal logistic regression analysis, the UA/Mg ratio remained independently associated with higher Gensini tertiles (OR = 2.34, 95% CI: 1.23–4.45; p = 0.009). In the ROC analysis, the UA/Mg ratio demonstrated excellent discriminative performance for identifying the high Gensini tertile (AUC = 0.907, 95% CI: 0.877–0.938). The AUC of the UA/Mg ratio was comparable to that of the UHR (DeLong p = 0.978), whereas it was significantly higher than that of the frontal QRS-T angle (DeLong p < 0.001). Conclusions: The uric acid-to-magnesium ratio was strongly and independently associated with the burden of angiographic coronary artery disease in patients undergoing elective coronary angiography. The UA/Mg ratio demonstrated discriminative performance comparable to that of the UHR and superior to the frontal QRS-T angle. These findings suggest that the UA/Mg ratio may serve as a complementary biomarker for assessing angiographic coronary artery disease burden. Further prospective studies are warranted to validate its clinical utility. Full article

Background: Invasive coronary angiography has historically been the reference standard for coronary, valvular, and structural heart disease. Over the past decade, coronary computed tomography angiography (CCTA), CT-derived fractional flow reserve (CT-FFR), photon-counting detector computed tomography (PCCT), and cardiac magnetic resonance (CMR) have expanded the range of clinical questions answerable without an intra-arterial catheter, but this shift has been uneven across clinical domains. Methods: We performed a narrative review and synthesis of randomized trials, registries, society guidelines, and consensus documents (2009–2026) identified through PubMed and major cardiovascular guideline databases, written from a joint cardiology and cardiac-surgical standpoint. Results: The boundary has shifted asymmetrically, by which we mean a domain-dependent rather than uniform displacement of invasive angiography. Non-invasive imaging is now established as the first-line approach for stable chest pain at low-to-moderate pretest probability, for pre-transcatheter aortic valve replacement (TAVR) and structural procedural planning, and for aortic disease. It remains contested for stable multivessel disease and pre-coronary artery bypass grafting (CABG) planning, where CCTA- or CT-FFR-only planning is still investigational. Invasive angiography stays first-line for ST-elevation myocardial infarction (STEMI), cardiogenic shock, and complex percutaneous coronary intervention (PCI), where diagnosis and therapy are inseparable. Conclusions: Invasive and non-invasive modalities are complementary rather than competing. The appropriate first-line investigation depends on the disease domain, pretest probability, anatomical complexity, imaging quality, and whether diagnosis and treatment can be separated. We propose a complexity-stratified, heart-team framework and identify the surgical research gaps that remain. Full article

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

Background: Coronary in-stent restenosis (ISR) remains a major limitation of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), adversely affecting long-term outcomes. Most available prediction models rely on invasive procedural variables and have been developed predominantly in high-income populations, limiting their generalizability. This study aimed to identify independent predictors of coronary ISR and to develop and internally validate a clinically applicable risk stratification model based on routinely available clinical, laboratory, and procedural factors in a cohort of patients from Kazakhstan. Methods: In this retrospective case–control study, 910 patients with coronary artery disease (CAD) who underwent follow-up coronary angiography after PCI between January 2018 and July 2025 were included. The study comprised 455 patients with angiographically confirmed coronary in-stent restenosis and 455 patients without restenosis selected using a consecutive sampling approach. Clinical characteristics, laboratory parameters, echocardiographic findings, and angiographic data were analyzed. Independent predictors were identified using multivariable binary logistic regression. Model discrimination was assessed using receiver operating characteristic (ROC) curve analysis, and internal validation was performed using bootstrap resampling. Results: The mean age was 62.9 ± 8.9 years, and 75.2% of patients were male. Restenosis was independently associated with prior myocardial infarction (MI) (OR 2.20; 95% CI 1.65–2.80), type 2 diabetes mellitus (T2DM) (OR 2.60; 95% CI 1.93–3.47), and smoking (OR 1.40; 95% CI 1.01–1.89). Patients with restenosis demonstrated a less favorable inflammatory and metabolic profile, including higher NLR, MHR, atherogenic index, and TyG index (all p < 0.05). LVEF was significantly lower, while multivessel disease and the number of implanted stents was higher (p < 0.001). A risk stratification model incorporating T2DM, the number of implanted stents, MPV, neutrophil count, HDL-C, LVEF demonstrated good discrimination (AUC 0.828) and 74.4% accuracy. Conclusions: The proposed model demonstrated good discrimination and satisfactory internal validity with limited optimism after internal bootstrap validation. It may serve as a useful tool for patient risk stratification after PCI. External validation in independent cohorts is required before widespread clinical implementation. Full article

Background: Cardiac arrest complicating acute coronary syndrome (ACS) is associated with high mortality and neurological morbidity despite advances in percutaneous coronary intervention (PCI) and post-resuscitation care. This study evaluated clinical outcomes in ACS patients presenting with cardiac arrest undergoing invasive coronary angiography, with particular focus on resuscitation status before catheterization and location of cardiac arrest. Methods: A retrospective analysis of 15,595 ACS patients undergoing coronary angiography between 2014 and 2025 identified two cohorts. The first cohort included 131 patients stratified according to mechanical cardiac activity upon arrival to the catheterization laboratory: previously resuscitated patients (RES, n = 109) and patients in refractory cardiac arrest requiring automatic resuscitation devices (ARD, n = 22). The second cohort included 159 patients grouped by arrest location: out-of-hospital (OHCA, n = 83), in-hospital (IHCA, n = 48), and catheterization laboratory cardiac arrest (CLCA, n = 28). The primary outcomes were in-hospital mortality and neurological status after resuscitation. Results: In-hospital mortality was significantly higher in the ARD group compared with the RES group (86.4% vs. 39.4%, p < 0.001). Survivors in the RES group more frequently achieved favorable neurological recovery (66.2%). Mean resuscitation duration and admission lactate levels were significantly greater in the ARD group (66.1 vs. 21.9 min, p < 0.001; 10.7 vs. 7.7 mmol/L, p = 0.006). According to arrest location, mortality was highest in the CLCA group (78.6%), followed by IHCA (60.4%) and OHCA (39.8%) (p < 0.001). Despite high mortality, all surviving CLCA patients had favorable neurological outcomes. Culprit coronary vessel distribution was not associated with mortality or neurological outcome. Conclusions: In ACS patients with cardiac arrest, ongoing refractory arrest during coronary angiography and cardiac arrest occurring in the catheterization laboratory were associated with markedly increased mortality. Successful resuscitation prior to catheterization was associated with significantly better survival and neurological recovery. Full article

Coronary artery aneurysm (CAA) and ectasia (CAE) are characterized by an abnormal dilation exceeding 1.5 times the reference diameter of the adjacent normal vessel segment. Usually, these vascular anomalies are detected incidentally during coronary computed tomography angiography or invasive coronary angiography. Their clinical significance has become increasingly recognized over time because they may be associated with myocardial ischemia, thrombosis, distal embolization, acute coronary syndromes, and adverse long-term outcomes. In adults, atherosclerosis remains the most frequent cause, while Kawasaki disease is the leading etiology in children. Many patients remain asymptomatic, and the diagnosis is often incidental. Given their variable natural history and poorly delineated prognostic implications, individualized clinical risk stratification is essential. Coronary angiography remains the gold standard for invasive assessment. Management remains controversial in the absence of randomized controlled trials establishing an optimal therapeutic strategy. Full article