Search Results (328)

Complex percutaneous coronary intervention (PCI) represents a growing proportion of contemporary coronary revascularization, driven by aging populations, increasing comorbidity burden, and advances in interventional techniques. Complex PCI encompasses a spectrum of anatomically and procedurally challenging lesions, including left main disease, bifurcation lesions requiring two-stent strategies, chronic total occlusions, long stent lengths, severe calcification requiring atherectomy, and multivessel revascularization. Antithrombotic therapy, comprising antiplatelet and anticoagulant agents, is essential for preventing stent thrombosis and other ischemic events in both the early and long-term phases after PCI. While antithrombotic therapy mitigates ischemic risks associated with complex PCI, these patients frequently carry a high bleeding risk, thus making the choice of antithrombotic regimen challenging. Recent guideline recommendations emphasize balancing ischemic and bleeding risks rather than relying solely on procedural complexity. This review synthesizes contemporary evidence, guideline recommendations, and clinical considerations for antithrombotic therapy after complex PCI. Full article

Background/Objectives: The prognostic significance of mucinous colorectal adenocarcinoma (MAC) is controversial. Some studies report good outcomes relative to conventional colorectal adenocarcinoma (CRC) as is similarly described for MACs in, e.g., the breast, lung, pancreas and prostate. However, other studies refute this, proclaiming either no difference or worse outcomes. Herein, we proffer additional insights into the biology of MAC to explain these conflicting findings. Methods: A literature search was undertaken using keywords pertaining to MAC. Archival cases from our database were analyzed to provide context for our findings. Main Findings: The unifying histologic feature of MACs is their >50% content of extracellular mucin, but they should not be viewed as a monolithic entity, as is commonly portrayed in databases. Instead, MAC is a heterogenous disease as defined by histologic and molecular phenotypes. For example, MACs arising from adenoma-like CRC have relatively good outcomes unlike those from traditional serrated adenomas. Likewise, other factors such as histologic grade (grade 1–3), genomics (e.g., BRAF, KRAS, TP53), microsatellite instability (MSI-H, MSI-L), consensus molecular subtypes (CMS1–CMS4), and mucin types (MUC2, MUC5AC) significantly influence prognosis. These pathophysiologic features, demographics (age and sex) and specific anatomic regions/topography (right/left colon/rectum) can be captured and used to improve prognostic stratification. Conclusions: In contrast to previous studies that largely demarcated MAC as a discrete entity, this paper shows the limitations of this approach by highlighting the various sub-entities comprising MAC. Recognition of this heterogeneity may help to inform future treatment algorithms. Full article

Background/Objectives: Despite advances in heart failure (HF) pharmacotherapy, novel treatments are needed for its main subtypes: preserved (HFpEF), mildly reduced (HFmrEF), and reduced (HFrEF) ejection fraction. Glucagon-like peptide-1 (GLP-1) based therapies have shown cardioprotective effects. We conducted a systematic review and meta-analysis (Prospero Registration Number CRD42024606997) assessing the efficacy of GLP-1 based therapies (GLP-1 receptor agonists including tirzepatide) across the spectrum of left ventricular ejection fraction on cardiovascular (CV) outcomes. Methods: The PubMed, Embase, Scopus and trial registries were searched until December 2025 for randomised controlled trials (RCTs) involving adults with HF treated with GLP-1 based therapies. Outcomes included heart failure hospitalisations (HFH), CV, and all-cause mortality. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses were performed by HF subtype, age, coronary artery disease (CAD) presence, and GLP-1 based therapeutic agent. Results: Fourteen RCTs (15,180 participants), at low risk of bias, were included. These agents significantly reduced HFH (RR: 0.84, 95% CI: 0.71–0.99), especially in HFpEF patients with stable CAD (RR: 0.61, 95% CI: 0.46–0.79). Limited data suggested benefits for exenatide in HFmrEF patients (RR: 0.67, 95% CI: 0.47–0.95). CV mortality was reduced in HFrEF patients <65 years old (RR: 0.71, 95% CI: 0.54–0.95). Benefit was seen in composites of HFH and CV mortality for HFpEF (RR: 0.67, 95% CI: 0.54–0.83). Conclusions: GLP-1 based therapies may reduce HFH in HFpEF and possibly lower CV mortality in younger HFrEF patients, suggesting phenotype-specific effects. Full article

Background: Cardiovascular complications are the main cause of early mortality in elderly patients after hip fracture surgery. Echocardiography, although suggested by guidelines to improve risk stratification, is frequently omitted due to the risk of delaying surgery. The aim of the study was to evaluate whether in a multidisciplinary hip fracture unit, echocardiography can be performed without a delay in surgery. The secondary endpoint was to research the possible association between echocardiographic abnormalities and in-hospital mortality. Methods: The study included hip fracture patients aged > 70 admitted in the period 1 January 2019 to 31 December 2024, to the hip fracture unit of a tertiary teaching hospital. Echocardiography was indicated according to clinical criteria (detection of heart murmur, pathological electrocardiographic changes, known heart disease and the presence of ≥3 coronary risk factors). In the study, there were 2272 patients; 1593 had indications for preoperative echocardiography, which was performed in 1502. Mean age was significantly higher in the ECHO group than in the NO ECHO group (85.4 ± 8 vs. 80.5 ± 11 years, p < 0.0001). ECHO group patients more frequently had at least two comorbidities and more severe functional impairment. In-hospital mortality was 7.3% in ECHO patients compared to 2.3% in NO ECHO patients. Results: Multivariate analysis showed that decreased left ventricular ejection fraction and pulmonary hypertension, as well as age, anemia, and reduced functional capacity expressed as lost BADL, were associated with in-hospital mortality. Conclusions: Echocardiography identifies a population at a high risk of in-hospital mortality, three times higher compared to the group of NO ECHO patients. In those who underwent echocardiography, a reduced left ventricular ejection fraction and an increase in pulmonary pressure were associated with in-hospital mortality. Full article

Tomato leaf diseases substantially reduce tomato yields and quality and remain a persistent challenge for efficient crop management. Although deep learning-based detectors have achieved strong accuracy in controlled benchmarks, many existing solutions are still difficult to transfer to resource-constrained agricultural systems because they rely on high-end GPUs, consume considerable power, and often lose performance after deployment on embedded devices. To address this practical gap, this study proposes HGS-YOLO, a system-oriented deployable lightweight adaptation of YOLOv11 for leaf-level tomato disease detection, together with an end-to-end edge sensing pipeline for low-power agricultural deployment. The main contribution lies in the coordinated system-level co-design of model structure, optimization, and deployment rather than in a novel detector architecture. Specifically, YOLOv11 is adapted through three coordinated modifications: an HGNetV2 backbone for efficient feature extraction, an HS-FPN neck with channel attention for lightweight multi-scale fusion, and an MPDIoU loss function for more stable localization optimization. Beyond the model architecture, the study establishes a complete engineering pipeline that includes training, optimization, post-training quantization, and hardware deployment with BPU acceleration on a D-Robotics RDK X5 handheld platform. Comprehensive benchmark experiments indicate that HGS-YOLO achieves 93.6% ${\mathrm{mAP}}_{50}$ and 72.1% mAP@[0.5:0.95] with 86.5% recall, only 1.3 M parameters, and a 3.1 MB model size, substantially reducing the model complexity and storage cost relative to the YOLOv11 baseline. A three-seed retraining comparison shows that HGS-YOLO trades roughly 0.5 ${\mathrm{mAP}}_{50}$ points for this compactness (a statistically significant but small concession) and recovers the cost on the deployment side: on the RDK X5 chip, HGS-YOLO is the fastest, most memory-efficient, and lowest-power model among all compared detectors. Indoor deployment tests using separately collected tomato leaf samples further achieve 90.3% ${\mathrm{mAP}}_{50}$, 82.3% recall, 89.0% precision, 25.0 ± 0.4 ms end-to-end latency, 40.0 ± 0.6 FPS, and 9.8 ± 0.4 W average system power. After PTQ, the ${\mathrm{mAP}}_{50}$ drops from 93.6% to 93.0% on the same benchmark; because this figure was measured under controlled imaging conditions, it is presented as an in-distribution reference point rather than as evidence of robustness in the open field. We also took the handheld system into a working tomato greenhouse for a small outdoor field round, where it ran end-to-end and produced on-device disease detections under natural sunlight, specular highlights, partial occlusion, background clutter, and handheld motion blur. These results show that HGS-YOLO reaches a good balance of accuracy, efficiency, and deployability and that it works in the field on an independent small-scale test; validating it more widely across sites, seasons, and weather is left to future work. Full article

Background: Accurate evaluation of stent implantation during percutaneous coronary intervention (PCI) is essential to reduce both early and late adverse events. Conventional coronary angiography, although routinely used, has limited spatial resolution and may fail to detect subtle mechanical abnormalities in implanted stents. Enhanced stent visualization (ESV) is an X-ray-based post-processing technique that improves delineation of stent struts without additional contrast or intracoronary instrumentation. Methods: We report a retrospective case series of five patients who underwent complex PCI where ESV was used as an adjunctive imaging modality. Clinical scenarios included left main interventions, bifurcation lesions, multivessel disease, and acute coronary syndromes. The ability of ESV to detect mechanical complications not evident on angiography was assessed. The impact of ESV on procedural decision-making was also assessed. Results: ESV enabled identification of mechanical complications in all cases, including stent fracture, stent loss, stent dislodgement, stent underexpansion, and geographical miss. These findings were not clearly appreciable when using angiography alone. In each case, ESV directly influenced intraprocedural management, prompting immediate corrective actions such as additional stent implantation, stent retrieval, or further optimization with post-dilatation or intravascular lithotripsy. This resulted in improved procedural outcomes and optimized stent deployment. Conclusions: In this small retrospective case series, ESV provided incremental diagnostic value over conventional angiography by detecting otherwise unrecognized mechanical complications and guiding real-time procedural optimization. While these findings suggest a potential role for ESV in complex PCIs, larger prospective studies are required to confirm its clinical impact. Full article

Background and Clinical Significance: This case highlights the management of chronic extensor carpi ulnaris (ECU) tenosynovitis in a patient exposed to non-traditional wrist-loading activities. Exercise therapy rehabilitation is well established in shoulder and knee tendinopathies, although it remains less well described for wrist tendinopathies beyond De Quervain’s disease. Moreover, the patient’s active engagement in non-traditional, wrist-intensive sports such as handstands, slacklining, and yoga may have contributed to the development and persistence of chronic extensor carpi ulnaris (ECU) tenosynovitis. Unlike more common ECU injuries observed in tennis or golf players, this case demonstrates how ECU tenosynovitis can develop in less conventional sports. It adds to the scientific literature by showing that chronic ECU tenosynovitis can be effectively managed through non-surgical rehabilitation tailored to the specific needs of the patient, in particular by using exercise therapy. Case Presentation: The patient presented with chronic left wrist pain, especially during ulnar deviation and resisted ECU testing, following two traumatic events. Examination revealed limited range of motion caused by pain, particularly in flexion, extension, and both ulnar and radial deviations. Ultrasound imaging confirmed ECU tenosynovitis with mild inflammation of other wrist tendons and a small synovial cyst on radio-scapho-lunate level. ECU stability during forearm rotation was confirmed both clinically and by ultrasound.  The diagnosis of chronic ECU tenosynovitis was managed conservatively with a targeted rehabilitation program focused on isometric strengthening and progressive resistance exercises. Over one month, the patient demonstrated marked improvement in wrist strength, pain reduction, and functional capacity, allowing for a gradual return to sporting activities. Conclusions: The main takeaway from this case is that chronic ECU tenosynovitis can be successfully managed through individualized, conservative treatment based on exercise therapy. Early intervention, patient adherence, and rehabilitation tailored to the athlete’s specific demands are crucial for recovery, even in chronic cases, without the need for surgical intervention. Full article

Since the first approval of CTLA-4 blockade for melanoma, immune checkpoint inhibitors (ICIs) have expanded into a major class of cancer therapy, with more than 100 FDA-approved oncological indications across metastatic and earlier-stage disease settings, including use as monotherapy and in combination regimens. Preclinical research has largely focused on myocarditis and atherosclerosis, but a wider set of phenotypes, such as non-inflammatory left ventricular dysfunction (NILVD), arrhythmias, and vasculitis, can be observed, and they are rarely connected within a single mechanistic model. We aim to build a systems-oriented, mechanistic framework of the most widely studied biological processes; it will link the main checkpoint pathways to relevant cardiac and vascular cell types, molecular pathways, immune synapses, and candidate biomarkers. We searched PubMed, Scopus, and Web of Science using combinations of terms for immune checkpoint inhibition and cardiovascular-immune-related adverse events that provide mechanistic insight into cardiac-immune-related adverse reactions (irAEs). An AI-assisted semantic clustering approach was used only to organize the included literature. The integrated framework identifies PD-1/PD-L1 as the dominant mechanistic hub linking T-cell activation, endothelial recruitment, myocardial injury, and vascular inflammation. Across phenotypes, a shared immune core involving checkpoint pathways, cytokine signaling, and leukocyte trafficking coexists with phenotype-restricted mediators that may bias injury toward myocarditis, vascular inflammation, conduction-system disease, or NILVD. KEGG analyses support the enrichment of T-cell receptor signaling, Th17 differentiation, JAK-STAT signaling, cytokine–cytokine receptor interaction, and lipid and atherosclerosis pathways. Candidate biomarkers emerging from the reviewed literature include troponin, IL-6, CXCL9/CXCL10/CXCL13, S100A family proteins, ROCK2, HLA-linked susceptibility signals, and T-cell receptor clonality markers. The AI-assisted clustering broadly recapitulated the expert-defined thematic structure while identifying finer semantic neighborhoods within the literature. This framework provides a support map for further hypotheses about toxicity patterns with current and next-generation checkpoint strategies on the cardiac system, while AI-assisted clustering provides a complementary method for organizing the literature rather than an independent source of biological inference. Full article

Coronary artery disease (CAD) often coexists with severe aortic stenosis (AS) in patients undergoing transcatheter aortic valve implantation (TAVI), posing a complex diagnostic and therapeutic challenge. As TAVI is increasingly used for younger, lower-risk patients, managing CAD is becoming a personalized, long-term clinical concern. This narrative review summarizes the current evidence on coronary assessment and revascularization strategies in individuals with severe AS. Invasive coronary angiography remains the leading method for anatomical coronary imaging, but coronary computed tomography angiography is emerging as a reliable alternative that may reduce unnecessary invasive procedures in certain patients. The routine performance of PCI before TAVI is under increasing scrutiny, and available data support a more selective approach based on lesion significance, CAD complexity, procedural timing, and anticipated need for future coronary access. Significant uncertainties remain concerning the physiological evaluation of lesions, the timing and completeness of revascularization, and the treatment of left main or multivessel disease. Additional phenotype-specific and longitudinal studies are needed to improve management algorithms for this population. Full article

Frontotemporal dementia (FTD) is a heterogeneous disorder for which disease-modifying treatments are lacking. Non-invasive brain stimulation (NIBS) has emerged as a potential therapeutic approach to modulate dysfunctional neural networks and support residual plasticity. This systematic review aims to provide an updated overview of current NIBS applications across the main clinical syndromes associated with FTD, namely behavioral variant FTD (bvFTD), semantic variant of primary progressive aphasia (svPPA), and nonfluent variant of PPA (nfvPPA). According to PRISMA guidelines, twenty-seven studies investigating NIBS interventions in major FTD phenotypes met the inclusion criteria, predominantly employing transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). tDCS, particularly when combined with language therapy, consistently improved several language abilities in PPA, with some evidence of maintenance over time. Benefits were most consistently reported in nfvPPA, whereas effects in svPPA were more limited and domain-specific. rTMS studies showed short-term improvements in language and executive functions, especially following stimulation of left frontal regions. In bvFTD, findings were heterogeneous, with social–cognitive outcomes appearing more sensitive to stimulation, whereas global cognitive measures showed more variable effects. NIBS, particularly tDCS combined with behavioral interventions, shows symptomatic potential in selected FTD phenotypes, but methodological heterogeneity and small samples warrant larger, well-controlled trials. Full article

Background/Objectives: Fractional flow reserve (FFR) is the reference standard for assessing the functional significance of intermediate coronary stenoses and guiding revascularization. Although a universal ischemic threshold is applied to all epicardial vessels, potential physiological differences between coronary territories remain insufficiently explored. The aim of this study was to evaluate whether the functional significance of intermediate coronary stenoses differs according to coronary artery and to assess the clinical outcomes of FFR-guided deferral across coronary territories. Methods: This single-center retrospective study included patients who underwent single-vessel FFR assessment for angiographically intermediate lesions between 2019 and 2022. Patients with left main disease or multivessel physiological assessment were excluded. Clinical characteristics, FFR values, and long-term outcomes were analyzed according to the investigated coronary artery. Major adverse cardiovascular events (MACE) were defined as a composite of death, myocardial infarction, and urgent revascularization. Results: A total of 310 patients (corresponding to 310 coronary arteries) were included: 211 LAD, 68 RCA, and 31 LCX lesions. Overall, 18.7% of lesions had a positive FFR (≤0.80). The only variable identified in univariable analysis as being associated with FFR positivity was the coronary artery evaluated (p < 0.001). Positive FFR values were observed in 24.6% of LAD lesions, compared with 8.8% in the RCA and none in the LCX. Among patients with negative FFR for whom revascularization was deferred, five-year MACE-free survival was similar across coronary territories (p = 0.12). Conclusions: The functional significance of intermediate coronary stenoses varies according to the coronary territory, with LAD lesions more frequently reaching ischemic thresholds. However, deferral of revascularization based on negative FFR is associated with favorable long-term outcomes across all vessels, supporting a vessel-specific physiological interpretation of coronary stenoses. Full article

Background: Unstable angina has become an exceedingly rare diagnosis in the era of high-sensitivity cardiac troponin (hs-cTn). Objectives: We sought to identify the incidence of unstable angina and characterize patients with low hs-cTn in emergency departments (EDs). Methods: A prespecified secondary analysis of the Rapid Acute Coronary Syndrome Exclusion using high-sensitivity cardiac Troponin I (RACE-IT) trial was conducted. RACE-IT was a stepped-wedge randomized trial comparing two rule-out protocols (0/1- and 0/3 h) for myocardial infarction (MI) in nine EDs from July 2020 to April 2021. All patients had hs-cTnI (Beckman Coulter) concentrations below or equal to the 99th percentile upper reference limit of 18 ng/L. The primary outcome was unstable angina, based on the ISCHEMIA trial definition, which required electrocardiographic changes or findings at coronary angiography (angiographic evidence of plaque rupture or thrombus). Results: Of the 32,608 patients in the trial, 60 patients (0.2%) met the definition of unstable angina, of whom 46 (77%) had obstructive disease at coronary angiography and 17 (28%) had an ischemic electrocardiogram. Coronary revascularization was performed in 45 (75%) patients and seven (12%) had left main or 3-vessel coronary artery disease. There were seven (12%) patients with non-obstructive coronary artery disease, and seven (12%) who had angiographically unremarkable coronary arteries. Patients with unstable angina were older (p = 0.015), more likely to be male (p = 0.005), with a higher prevalence of hypertension (p < 0.001), known coronary artery disease (p < 0.001), peripheral vascular disease (p = 0.035), and a higher serum creatinine (p = 0.018). At 30 days, two patients had a type 1 MI and there were no deaths. Conclusions: Unstable angina was diagnosed in 1 in 500 patients with a low hs-cTnI value at presentation to the ED and these patients had an excellent prognosis at 30 days. These patients tend not to have high-risk anatomy and one in four had non-obstructive coronary artery disease or angiographically unremarkable coronary arteries. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

Zone 2 thoracic endovascular aortic repair (TEVAR) frequently requires left subclavian artery (LSA) preservation to maintain vertebrobasilar and upper-extremity perfusion while obtaining a durable proximal seal. Dedicated single-branch endografts were developed to standardize this step and to facilitate a reproducible fully endovascular strategy. Two main device concepts currently shape this field: integrated unibody branch platforms, represented by Castor and the second-generation Cratos, and modular retrograde-branch systems, represented by the Gore TAG Thoracic Branch Endoprosthesis (TBE). The Castor/Cratos evidence base is broader and older, and is mainly centered on type B aortic dissection, with prospective multicenter and real-world data showing favorable branch patency and aortic remodeling. By contrast, TBE evidence is expanding rapidly and is supported by prospective midterm data in arch aneurysms as well as by increasingly large post-commercial series and comparative analyses across zones 0–2. Beyond outcomes, the two platforms differ substantially in branch directionality, potential contribution to proximal fixation, modularity, branch diameter range, proximal landing requirements, access profile, and regulatory/off-the-shelf availability, all of which have direct consequences for anatomical suitability in dissection, aneurysm disease, and trauma. This narrative review synthesizes current evidence and proposes an anatomy-first, pathology-aware framework for selecting between Castor/Cratos and TBE in totally endovascular zone 2 TEVAR with LSA revascularization. Full article

Background: Sortilin (SORT1), linked to the 1p13.3 coronary risk locus, is implicated in lipid trafficking and atherogenesis; however, clinical studies of circulating SORT1 have produced inconsistent results. We evaluated whether circulating SORT1 is associated with angiographic burden and lesion localization in patients with premature or early clinical debut coronary atherosclerosis. Methods: This single-center, cross-sectional study analyzed a dataset collected from January to May 2023. Participants were classified as coronary atherosclerosis cases if the dataset contained an age of clinical debut of clinically significant atherosclerosis (n = 101). Controls had no recorded debut age and 0% stenosis in all assessed coronary segments (n = 27). Blood was collected in clot activator tubes; serum was stored at −40 °C until analysis. SORT1 (ng/mL) was measured using an Aviscera Bioscience ELISA. Coronary stenoses were recorded as percent diameter stenosis for left main (LM), proximal/mid/distal LAD, proximal/mid/distal LCx, and proximal/mid/distal RCA. Burden metrics included the number of segments with any stenosis (>0%), the number of obstructive segments (≥50%), the number of diseased vessels, and maximum stenosis. The prespecified primary endpoint was obstructive proximal LAD stenosis (≥50%). Nonparametric tests and Spearman correlations were used. Logistic regression evaluated the association between log2-transformed SORT1 and proximal LAD obstruction, adjusted for age, sex, LDL-C, statin use, and smoking/diabetes/hypertension durations. Results: SORT1 was higher in cases than controls (8.60 [2.60–17.10] vs. 2.30 [1.25–10.65] ng/mL; p = 0.0058). Within cases, SORT1 did not correlate with global angiographic burden (any-stenosis segments: ρ = −0.066, p = 0.513; obstructive segments: ρ = −0.060, p = 0.552; diseased vessels: ρ = −0.045, p = 0.652; maximum stenosis: ρ = −0.084, p = 0.403). Obstructive proximal LAD stenosis occurred in 44/101 (43.6%) and was associated with higher SORT1 (12.25 [4.18–17.45] vs. 4.10 [2.20–11.60] ng/mL; p = 0.0093). Each doubling of SORT1 was independently associated with proximal LAD obstruction (adjusted OR 1.48, 95% CI 1.12–1.95; p = 0.005). Conclusions: In this cross-sectional cohort, circulating SORT1 was associated with obstructive proximal LAD stenosis but not with global angiographic burden metrics. These findings are hypothesis-generating and warrant validation in independent cohorts with standardized preanalytics and prospective designs to assess temporal relationships and clinical utility. Full article