Search Results (603)

Background/Objectives: Coronary artery disease (CAD) is highly prevalent in patients undergoing vascular surgery and is a major determinant of postoperative morbidity and mortality. Preoperative anemia is a well-recognized risk factor for adverse outcomes, including major adverse cardiac events (MACEs), but its independent impact in patients with CAD undergoing abdominal aortic aneurysm (AAA) repair remains unclear. Methods: We conducted a retrospective cohort study of 410 consecutive patients undergoing open AAA repair at a tertiary vascular center between 2023 and 2025. Preoperative anemia was defined as hemoglobin < 130 g/L and significant CAD as ≥70% luminal narrowing for non-left main disease or ≥50% for left main disease. The primary outcome was MACE (cardiovascular death, myocardial infarction, or stroke) during hospitalization. Baseline covariates included age, sex, diabetes mellitus (DM), chronic kidney disease (CKD), congestive heart failure (CHF), peripheral artery disease (PAD), and other relevant comorbidities. Multivariable logistic regression models were used to evaluate associations of anemia, CAD, and their interaction with MACE. Additionally, a composite risk group was created to examine MACE rates across mutually exclusive subgroups. Results: Among 410 patients, 314 (76.6%) had CAD and 116 (28.3%) had preoperative anemia. Overall, 67 patients (16.3%) experienced MACE. In the reduced model including only anemia and CAD, anemia remained a strong independent predictor of a MACE (OR 4.46, 95% CI 2.57–7.72, p < 0.001), and CAD was also independently associated (OR 2.20, 95% CI 1.00–4.72, p = 0.044). In the full multivariable model adjusting for DM, CHF, CKD, PAD, and age, anemia was the strongest predictor (OR 4.53, 95% CI 2.49–8.26, p < 0.001), while CAD showed a borderline association (OR 2.07, 95% CI 0.94–4.57, p = 0.071). Interaction analysis indicated no statistically significant modification in risk by the combination of anemia and CAD. The composite risk group variable was omitted due to collinearity with its components. Conclusions: Preoperative anemia, particularly in patients with CAD, is a significant and independent predictor of major adverse cardiac events following open AAA repair. These findings support the importance of early identification and correction of anemia before surgery to improve perioperative cardiac outcomes in this high-risk population. Full article

Background: Coronary artery bypass grafting (CABG) is a well-established revascularization strategy for patients with multivessel coronary artery disease. The effectiveness of CABG is significantly influenced by antiplatelet therapy aimed at maintaining graft patency and reducing thrombotic complications. However, substantial inter-individual variability exists in platelet function responses to standard therapies such as aspirin and clopidogrel, leading to antiplatelet resistance. This variability has been linked to increased risks of myocardial infarction, stroke, and early graft failure. Platelet function testing (PFT) offers a potential strategy to identify resistance and guide more personalized antiplatelet therapy. This study aims to evaluate the association between perioperative platelet function test results and clinical outcomes following CABG. By assessing platelet responsiveness at multiple timepoints and correlating findings with postoperative events, the study seeks to determine whether PFT can stratify risk and improve patient management. Methods: This is a prospective, single-centre, observational cohort study conducted at a tertiary NHS cardiac surgery centre. Patients having elective or urgent isolated CABG will be enrolled and undergo perioperative PFT using the TEG6s system. Clinical outcomes will be monitored for 12 months postoperatively, with primary endpoints assessing the correlation between platelet function results and major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints will include the prevalence of antiplatelet resistance, demographic predictors, and the feasibility of integrating PFT into clinical workflows. Results: This study will report the prevalence of aspirin and clopidogrel resistance in CABG patients based on TEG6s PFT, as well as the correlation between platelet function results and MACCE, postoperative bleeding, and the need for surgical re-exploration. Additionally, it will examine the associations between demographic and clinical factors—such as diabetes status, renal function, BMI, and surgical technique—and variability in platelet responsiveness. The feasibility of incorporating PFT into perioperative workflows will also be evaluated, assessing whether results could support personalized antiplatelet management in future clinical trials. Conclusions: Findings from this study will provide real-world evidence regarding platelet function variability in CABG patients and suggest that PFT may identify those at increased risk of thrombotic complications. This exploratory analysis supports the need for larger interventional trials aimed at optimizing individualized postoperative antiplatelet therapy to improve surgical outcomes. Full article

Coronary bifurcation lesions are considered among the most challenging lesions to treat with percutaneous coronary intervention (PCI), particularly in cases of extensively diseased branches. In the event of failure of a provisional (one-stent) approach, many two-stent bifurcation techniques can be performed for the treatment of coronary bifurcation lesions. Two techniques (culotte and T/TAP) are suggested by the European Bifurcation Club, but a reverse crush is performed by some operators. This study aims to retrospectively compare these two different approaches (EBC-recommended techniques vs. reverse crush). Full article

Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) in percutaneous coronary intervention, delivering antiproliferative drugs without leaving a permanent implant. This review provides a comparative analysis of sirolimus-coated DCBs (DCB-S), paclitaxel-coated DCBs (DCB-P), and DESs across key scenarios: de novo coronary lesions in chronic coronary syndrome (CCS), acute coronary syndromes (ACS), and in-stent restenosis (ISR). We discuss late lumen loss (LLL), target lesion/vessel revascularization (TLR/TVR), vessel patency, and major adverse cardiac events (MACE) outcomes, along with current guidelines and emerging indications for DCB-S. We also examine pharmacological differences between sirolimus and paclitaxel (mechanisms of action, tissue uptake, and healing profiles), trial methodologies, and recent innovations in DCB technology. Across stable de novo lesions (especially small vessels and high bleeding-risk patients), multiple trials show DCB-P can achieve non-inferior clinical outcomes to DES. Early data suggest newer DCB-S may likewise match DES outcomes in broader populations. In ACS, DCB-only strategies have demonstrated feasibility and safety in carefully selected lesions without heavy thrombus, with randomized studies like REVELATION (STEMI) showing non-inferior fractional flow reserve and low revascularization rates compared to DES. For ISR, DCB-P is an established Class I treatment in both BMS-ISR and DES-ISR, yielding similar or lower TLR rates than repeat stenting. DCB-S are now being evaluated as an alternative in ISR, aiming to avoid additional stent layers. Contemporary guidelines endorse DCB use in ISR and small vessels, and experts anticipate expanding indications as evidence grows. Sirolimus and paclitaxel differ in antiproliferative mechanisms and pharmacokinetics—sirolimus (cytostatic, mTOR inhibition) may offer faster endothelial recovery, whereas paclitaxel’s high lipophilicity ensures sustained arterial wall retention. Technological advances (e.g., phospholipid micro-reservoirs for sirolimus) are enhancing drug transfer and addressing prior limitations. In summary, DCB-P and DCB-S now represent viable alternatives to DES in specific scenarios, especially where “leaving nothing behind” could reduce long-term complications. Ongoing large randomized trials, such as SELUTION DeNovo, currently available as conference-presented data, together with longer-term follow-up will further clarify the optimal niches for DCB-S versus DCB-P and DES. Full article

The pathophysiology of ST-elevated myocardial infarction (STEMI) extends beyond coronary artery occlusion to include microvascular and endothelial dysfunction, both of which critically influence outcomes. Endocan, a soluble dermatan sulfate proteoglycan secreted by endothelial cells, has emerged as a novel biomarker of endothelial activation and dysfunction. Recent studies suggest that elevated endocan levels may carry prognostic significance in patients with STEMI, particularly those undergoing percutaneous coronary intervention (PCI). A comprehensive search of PubMed, Cochrane Library, and Google Scholar was conducted to identify studies evaluating endocan as a prognostic biomarker in STEMI. Review articles, case reports, case series, and experimental studies were excluded. Seven clinical studies, comprising sample sizes ranging from 80 to 320 patients, met the inclusion criteria. Across these studies, endocan levels were analyzed in relation to established prognostic markers and clinical outcomes. Key findings demonstrated that higher endocan levels correlated with stress hyperglycemia (r = 0.21, p < 0.05), higher SYNTAX scores, and worse in-hospital outcomes. A cutoff value of 1.7 ng/mL predicted STEMI with 76.1% sensitivity and 73.6% specificity. Elevated endocan levels also showed positive correlations with the TIMI risk score, major adverse cardiovascular events (MACE), and were identified as independent predictors of incomplete ST-segment resolution (STR) (p = 0.044) and no-reflow phenomenon (NRP) (p < 0.001, OR = 2.39, 95% CI = 1.37–4.15). Collectively, the evidence indicates that endocan is strongly associated with endothelial dysfunction, MACE, NRP post-PCI, and impaired reperfusion. Moreover, traditional prognostic indices such as TIMI and SYNTAX scores appear to correlate with circulating endocan levels. However, variability in reported cutoff values across studies highlights the need for larger, multicenter trials with standardized endpoints to establish endocan’s diagnostic and prognostic utility in STEMI. Full article

Background/Objectives: Limited information exists on the burden of major cardiovascular morbidity in elderly patients with chronic coronary syndrome (CCS). Our objective was to investigate the cumulative incidence of lifetime hospitalizations for major cardiovascular events (MCE) in patients aged 75 years or older with CCS and to identify clinical predictors of these events. Methods: All consecutive outpatients aged 75 years or older with CCS seen in two consultations at a tertiary hospital between 2000 and 2008 were included in a prospective study and followed until death. All MCEs requiring admission (hospitalizations for heart failure (HF), acute myocardial infarction, and stroke) were recorded, and the cumulative incidence of each event and the combination of all events was calculated, considering death without admission as a competing event. Results: A total of 414 patients were selected (mean age was 79 ± 4 years, 36% women). After a 22-year follow-up (median 7 years, p25–75 4–11), 198 patients (48%) experienced at least one MCE, the most common being hospitalization for HF (122 patients had 209 hospitalizations). The 10 and 20-year cumulative incidence was 41% (95% CI 36–46%) and 48% (43–53%) for any event. In multivariate analysis, independent predictors of hospitalization for MCE were hypertension (HR 1.58 [95% CI:1.15–2.18], p = 0.005), diabetes (HR 1.38 [1.03–1.85], p = 0.031), prior HF (HR 2.52 [1.59–4.01], p < 0.0005), and atrial fibrillation (HR:1.68 [1.13–2.50], p = 0.011). Conclusions: Nearly half of elderly patients with CCS were hospitalized for MCE during their lifetime. HF was the most common event. Several clinical variables could be useful to stratify the risk of events. Full article

Background: There are limited data about the use of drug-coated balloon (DCB)-only angioplasty for multivessel coronary disease. Objectives: The aim of this study was to assess the safety and efficacy of DCB-only angioplasty as compared with second-generation drug-eluting stents (DESs) in patients undergoing multivessel angioplasty. Methods: We compared major adverse cardiovascular events (MACEs) in all patients undergoing multivessel angioplasty in our institution from 1 January 2015 until 15 November 2019, with either the DCB-only or DES-only strategy. The primary endpoint of our study was a MACE, including cardiovascular mortality, acute coronary syndrome, target lesion revascularisation, stroke, or major bleeding. Data were analysed using Cox regression models, Kaplan–Meier estimator plots, and propensity score matching. Results: A total of 159 consecutive patients treated with DCB-only angioplasty and 222 consecutive patients treated with DES-only angioplasty were identified. The majority of the vessels treated were large vessels (>3 mm). After a median follow-up of 4 years, a total of 52 (33%) patients in the DCB and 73 (33%) patients in the DES group encountered a MACE (p = 0.97). The results did not change following propensity score matching. On multivariate Cox regression analysis in the propensity score-matched cohort, atrial fibrillation [HR = 2.37, CI: (1.22–4.61), p = 0.011] and diabetes [HR = 1.71, CI: (1.13–2.60), p = 0.011] were the only independent adverse predictors of MACE. Conclusions: DCB-only angioplasty appears to be safe and efficient when compared to DES for multivessel angioplasty in terms of MACEs after a follow-up of 4 years. Full article

Background and Objectives: Chronic kidney disease (CKD) is frequently observed among patients with non–ST elevation myocardial infarction (NSTEMI) and is associated with increased morbidity and mortality. Evidence comparing long-term outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in this high-risk population remains limited. The objective was to compare long-term major adverse cardiac event (MACE) outcomes between PCI and CABG in NSTEMI patients with CKD and multivessel disease. Materials and Methods: A total of 150 consecutive NSTEMI patients with CKD who underwent PCI or CABG were included in this retrospective observational cohort study. Patients were classified as having mild or moderate-to-severe CKD based on eGFR. Long-term outcomes included MACE (death, myocardial infarction, or ischemia-driven revascularization). Kaplan–Meier analysis was used to compare long-term MACE-free survival between groups. Results: PCI (n = 68) and CABG (n = 82) groups demonstrated comparable long-term MACE-free survival (log-rank p = 0.41). One-year MACE-free survival rates were 78% and 82%, respectively. Ischemia-driven revascularization was more frequent after PCI (p = 0.028), whereas major bleeding occurred more commonly after CABG (p = 0.003). Conclusions: In NSTEMI patients with CKD and multivessel disease, PCI and CABG provide comparable long-term MACE-free survival. Despite higher rates of repeat revascularization after PCI and greater bleeding risk after CABG, overall long-term outcomes were similar. CKD severity did not significantly modify treatment-related differences. Full article

Background: The impact of diabetes on the management and outcomes of patients with borderline CT-derived fractional flow reserve (FFR_CT) remains unclear. Methods: This multicenter study enrolled symptomatic patients with suspected coronary artery disease who underwent Coronary computed tomography angiography (CCTA) between June 2021 and May 2023, yielding FFR_CT values between 0.70 and 0.80. Revascularization occurring within 90 days after CCTA was documented. The endpoint was major adverse cardiovascular events (MACE), as a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization. Outcomes were analyzed using Cox proportional hazards models, while the relationship between FFR_CT and MACE was examined using restricted cubic spline analysis (RCS). Results: This analysis included 1515 patients with borderline FFR_CT values, comprising 503 (33.2%) with diabetes. Over a median follow-up of 985 days, 117 MACE occurred. Multivariate analysis showed that revascularization was independently associated with a reduced risk of the endpoint, a protective effect consistent in both non-diabetic (adjusted HR [aHR] 0.53, 95% CI 0.29–0.96; p = 0.036) and diabetic patients (aHR 0.25, 95% CI 0.09–0.71; p = 0.009). RCS revealed a significant non-linear relationship between FFR_CT and MACE in non-diabetic patients (p = 0.002). Conclusions: In patients with borderline FFR_CT, revascularization was linked to a lower incidence of MACE, and this association was consistent regardless of diabetes status. Full article

Background: This study aimed to assess the efficacy, optimal dosing, and timing of colchicine therapy in reducing major adverse cardiovascular events (MACE), its impact on inflammatory markers, and safety concerns in patients following acute coronary syndrome (ACS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted in accordance with PRISMA guidelines to identify RCTs comparing colchicine versus placebo or standard treatment in ACS patients. The primary outcome was MACE and secondary outcomes included all-cause and cardiovascular mortality, non-fatal MI, stroke, revascularization, heart failure, CRP/hs-CRP changes, and adverse effects. Fifteen RCTs involving 19,131 patients were analyzed. Results: The benefit of colchicine in reducing MACE risk was marginally significant (RR = 0.79, 95% CI: 0.63–0.99, p = 0.04, I² = 59%). No significant reduction was observed for all-cause mortality, cardiovascular mortality, other cardiovascular outcomes, early initiation of colchicine (≤3 days), or choice of dosage (≤0.5 mg/day vs. >0.5 mg/day). The findings pertaining to the delayed time-to-initiation (>3 days) and changes in CRP or hs-CRP levels were inconclusive. Gastrointestinal side effects, especially diarrhea (RR = 1.76, 95% CI: 1.16–2.66, p = 0.001), were most common. No increase in hematologic events or infections was observed. Conclusions: Colchicine potentially reduces MACE in ACS patients, without evidence of benefit in improving all-cause mortality or other cardiovascular outcomes. Gastrointestinal intolerance is the most common side effect. This result is consistent with current clinical guidelines: a Class IIb recommendation for colchicine use in ACS. There is a need for further high-quality trials to refine patient selection and optimize treatment regimens. Full article

Residual cardiovascular risk remains a major challenge in coronary artery disease, even after optimal lipid-lowering and anti-inflammatory therapy. Beyond classical risk factors, persistent low-grade inflammation and fibrotic remodeling contribute to adverse outcomes that current treatments fail to fully prevent. Growing evidence highlights the glyco-inflammatory axis—the interplay between protein glycosylation-dependent signaling and inflammation—as an underappreciated contributor to residual atherosclerotic risk, largely because current therapeutic strategies do not directly target glycan-mediated mechanisms. Within this framework, Galectin-3 (Gal-3), a β-galactoside-binding lectin, has emerged as a key molecular hub linking metabolic stress, lysosomal dysfunction, and vascular remodeling. By recognizing specific glycan motifs on immune and stromal cells, Gal-3 orchestrates macrophage activation, endothelial dysfunction, and extracellular matrix deposition, thereby amplifying chronic inflammation and fibrosis. Elevated circulating Gal-3 levels are associated with plaque vulnerability and major adverse cardiovascular events, independent of lipid or C-reactive protein levels. Experimental Gal-3 inhibition reduces inflammation and fibrosis in preclinical models, supporting its therapeutic potential. This review integrates mechanistic, translational, and clinical evidence to propose Gal-3 as a missing link between intracellular stress responses and extracellular fibro-inflammatory remodeling. Targeting the Gal-3-mediated glyco-inflammatory axis may represent a novel strategy to overcome residual cardiovascular risk and achieve comprehensive vascular protection in the post-statin era. Full article

ST-elevation myocardial infarction (STEMI) remains a major health concern despite advances in care. Indoxyl sulfate (IS) and p-cresyl-sulfate (p-CS) are gut-derived uremic toxins linked to higher morbidity and mortality in patients with chronic kidney disease (CKD). IS has been identified as an independent predictor of major adverse cardiovascular events (MACE) after STEMI, but data on p-CS are lacking. This study assessed the predictive value of IS and p-CS in STEMI patients with preserved renal function (cohort # NCT03070496). Plasma IS and p-CS were measured in 260 patients with STEMI who underwent primary coronary angiography. Samples collected 4 h after inclusion were analyzed using ultra-performance liquid chromatography with fluorescence detection. Optimal cut-offs were determined by the Youden index, and associations with MACE were evaluated by log-rank tests and Cox regression. Among 234 analyzed patients, 11.5% experienced MACE within one year. IS and p-CS levels were higher in the MACE group (IS: 3.14 vs. 2.19 µmol/L, p < 0.05; p-CS: 6.76 vs. 2.70 µmol/L, p < 0.01). Elevated p-CS independently predicted MACE (HR 3.79, 95% CI 1.29–11.17, p < 0.05), whereas IS lost significance after adjusting for kidney function. In STEMI patients, plasma p-CS is a stronger independent predictor of MACE than IS, highlighting its potential role in the gut–heart axis. Full article

Background: Acute coronary syndrome (ACS) encompasses ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina. While optimal medical therapy (OMT) is central to secondary prevention, lifestyle interventions—particularly dietary modification—remain underutilised despite their potential impact on long-term outcomes. Objective: To review the current evidence regarding dietary interventions post-ACS, their implementation, adherence, and effects on cardiovascular risk factors and clinical outcomes. Methods: A narrative literature review was performed using PubMed, including studies published in English from 2000 onwards. Keywords included “acute coronary syndrome,” “diet,” “cardiovascular disease,” “outcomes,” “adherence,” “wine,” and “intermittent fasting,” combined with Boolean operators AND/OR. Animal studies were excluded. The latest search was conducted in October 2025. Results: Mediterranean-style diets, when combined with OMT and lifestyle interventions (exercise, smoking cessation, alcohol moderation), consistently improve cardiovascular risk factors and reduce recurrent ischemic events and mortality. Clinical trials and cohort studies demonstrate long-term benefits, including reductions in all-cause mortality and major adverse cardiovascular events, particularly in patients adhering to structured dietary programmes within cardiac rehabilitation. Evidence for other dietary modifications, including low-fat diets, increased fibre, antioxidant supplementation, and intermittent fasting, was more limited, often derived from small or short-term studies focusing on surrogate endpoints. Real-world adherence to dietary guidelines remains suboptimal, especially in high-risk and obese populations. Preliminary studies suggest intermittent fasting and moderate red wine consumption may confer additional cardiovascular benefits, though larger, long-term trials are needed. Conclusions: Dietary modification is a key, yet underutilised component of secondary prevention post-ACS. A Mediterranean-style, whole-food diet integrated with OMT and supported by structured cardiac rehabilitation programmes offers the most evidence-based strategy to improve risk factor control and long-term outcomes. Future research should focus on pragmatic, long-term trials assessing hard cardiovascular endpoints and implementation strategies to enhance adherence across diverse populations. Full article

Background: Inflammation is a central driver of atherothrombosis, yet the temporal behavior of key inflammasome mediators following acute coronary syndrome (ACS) is not well characterized. The NLRP3 inflammasome, a major regulator of interleukin (IL)-1β activation, has been implicated in plaque destabilization and recurrent cardiovascular risk. This study aims to investigate the temporal expression of NLRP3 inflammasome components in peripheral blood mononuclear cells (PBMCs) of patients with ACS. Methods: In this prospective observational study, PBMCs were collected from 73 patients with ACS during the early in-hospital phase and at 8–12 weeks follow-up. Gene expression of NLRP3, caspase-1, and IL-1β was quantified by qRT-PCR, and fold-change was calculated using the 2^−ΔΔCT method. Associations with clinical and biochemical variables were evaluated using multivariable linear regression. Results: Expression of all measured inflammasome-related genes increased significantly at follow-up compared with baseline: caspase-1 (≈2-fold, p = 0.003), NLRP3 (>10-fold, p < 0.001), and IL-1β (≈4-fold, p < 0.001). Subgroup analyses showed that the post-ACS upregulation of NLRP3, caspase-1, and IL-1β was consistent across STEMI and NSTEMI presentations and was not significantly modified by diabetes status. Caspase-1 fold-change correlated positively with IL-1β, LDL-cholesterol, peak troponin I, and high sensitivity C reactive protein, whereas NLRP3 showed minimal correlations with clinical variables. In multivariable analysis, caspase-1 upregulation was independently associated with STEMI presentation and low-density lipoprotein-cholesterol, and IL-1β with type 2 diabetes. Conclusions: Patients with ACS exhibit significant and persistent upregulation of NLRP3 inflammasome components weeks after the acute event, indicating sustained immune cell priming during recovery. These findings highlight a potential molecular substrate for residual inflammatory risk and support further exploration of inflammasome-targeted therapies in the post-ACS period. Full article

Percutaneous coronary intervention (PCI) has evolved significantly over the past two decades, yet challenges in achieving optimal stent deployment and long-term outcomes persist, particularly in complex coronary anatomy. Intravascular imaging (IVI) modalities such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS) have transformed the precision of PCI by providing detailed cross-sectional visualization of vessel architecture, plaque morphology, and stent apposition. Compared to angiography-guided PCI, imaging-guided PCI enables more accurate lesion assessment, appropriate stent sizing, and detection of suboptimal results including under-expansion, malapposition, and edge dissections, factors strongly linked to restenosis and stent thrombosis. Large-scale randomized trials (e.g., ULTIMATE, ILUMIEN) and meta-analyses have demonstrated that imaging-guided PCI reduces major adverse cardiovascular events (MACE) and improves long-term stent patency, particularly in left main, bifurcation, and calcified lesions. Despite these benefits, adoption remains variable due to cost, procedural complexity, and training gaps. Emerging advances, including artificial intelligence-enhanced imaging, hybrid devices, and fusion of imaging with physiologic assessments, promise to integrate imaging more seamlessly into routine practice. This review summarizes current evidence, practical applications, and future directions of IVI-guided PCI, underscoring its growing role in contemporary interventional cardiology and its potential to personalize and optimize coronary revascularization strategies. Full article