Search Results (125)

Background: Patients with acute myocardial infarction (AMI) who experience in-hospital heart failure (HF) would present a higher risk for fatal events. This study aims to develop and validate a simple-to-use diagnostic nomogram to identify high-risk individuals for in-hospital HF in patients with AMI. Methods: Using data from CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project (2014–2019), this study included 74,697 patients with ST elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who admitted within 24 h after symptom onset, without HF, cardiac arrest, or cardiac shock at admission. Independent predictors were identified through univariate logistic regression analyses and least absolute shrinkage and selection operator (LASSO) regression. A nomogram was subsequently constructed based on multivariate logistic regression. The model’s performance was evaluated by its discrimination and calibration, assessed using Harrell’s C-index and calibration curves with Hosmer–Lemeshow goodness-of-fit tests, respectively. Results: Six predictors were selected for the final nomogram, including age, heart rate, history of atrial fibrillation, history of chronic obstructive pulmonary disease, history of chronic HF, and history of chronic kidney disease. The nomogram demonstrated a C-index of 0.68 (95% CI: 0.66–0.69) in the training cohort and 0.67 (95% CI: 0.66–0.69) in the validation cohort. The calibration curves of the nomogram showed a strong calibration, as Hosmer–Lemeshow goodness-of-fit tests yielded chi-squares of 11.00 (p = 0.21) and 8.48 (p = 0.39) for the training and validation cohort, respectively. Conclusions: This simple-to-use nomogram for effectively predicting the risk for in-hospital HF may be used as a helpful tool in clinical decision-making during treatment and management in patients with AMI. Full article

Background: Ticagrelor is a reversible, direct inhibitor of the platelet adenosine diphosphate (P2Y12) receptor, widely used in combination with acetylsalicylic acid (ASA) as dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) to prevent cardiovascular events. Despite its well-established efficacy, ticagrelor may cause adverse effects ranging from common ones (e.g., bleeding, dyspnea) to rare but potentially serious reactions such as bradyarrhythmias. These rare events are likely related to elevated adenosine levels secondary to inhibition of the human equilibrative nucleoside transporter 1 (hENT1). Methods: We describe two clinical cases of ticagrelor-associated bradyarrhythmia observed in patients following ACS. Both cases were analyzed in terms of clinical presentation, ECG findings, management strategy, and outcomes after discontinuation of the drug. Results: The first case concerns a 67-year-old woman with non-ST-segment elevation myocardial infarction (NSTEMI) who developed complete atrioventricular block (third degree) with a 45 s asystolic pause and syncope. The second case involves a 67-year-old man with anterior ST-segment elevation myocardial infarction (STEMI) who experienced recurrent sinus pauses lasting up to 5 s. In both cases, symptoms resolved following ticagrelor discontinuation and theophylline administration. No recurrence of arrhythmia was observed after switching to prasugrel. Conclusions: Ticagrelor-induced bradyarrhythmias, although rare, represent an important and reversible adverse effect that clinicians should be aware of, particularly during the early post-ACS phase. Prompt recognition and drug withdrawal may prevent severe outcomes and avoid unnecessary interventions such as pacemaker implantation. Further studies are warranted to identify patient-specific risk factors predisposing to ticagrelor-related conduction disturbances. 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: Acute chest pain is a common emergency with only 10–20% of cases attributable to acute coronary syndrome (ACS). Rapid and accurate pre-hospital diagnosis remains challenging, particularly for non-ST elevation ACS, where ECG findings may be inconclusive. AI-guided focused cardiac ultrasound (FoCUS) using handheld devices offers a potential solution by enabling immediate functional cardiac assessment. The aim was to investigate the feasibility and diagnostic performance of pre-hospital AI-guided FoCUS for detecting ACS in patients with acute chest pain. Methods: In this single-center, prospective pilot study, 75 patients with acute chest pain were enrolled. FoCUS examinations were performed by experienced sonographers (72%) and EMS paramedics (28%) using AI-guidance for obtaining the apical 4-chamber (AP4CH), apical 2-chamber (AP2CH), and apical 3-chamber (AP3CH) views. The quality of the obtained images was assessed, and quantitative measurements—including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS)—were analyzed. Diagnostic performance was subsequently evaluated using ROC curve analysis. Results: At least one apical view was acquired in 91% of patients, with sonographer achieving higher acquisition rates than paramedics (96% vs. 67% for the AP4CH view). Complete acquisition of all apical views was achieved in 67% of cases (83% vs. 24%), and image quality was high across views, with median scores ranging from 83% to 100%. GLS yielded an AUC of 0.76 (89% sensitivity, 56% specificity) and LVEF yielded an AUC of 0.65 (75% sensitivity, 73% specificity). In patients with intermediate to high HEAR-scores (>3), lower LS-AP4CH values were associated with ACS. Conclusion: Pre-hospital AI-guided FoCUS is feasible and shows promise for ACS detection, although quantitative parameters do not yet outperform established clinical scores. Enhanced training and further refinement of AI algorithms are needed before widespread implementation. Full article

Background and Objectives: There are few studies suggesting that the Triglyceride–Glucose Index (TyG), which is mostly defined as a predictor of diabetes, can be used as a predictor of coronary artery disease. In this study, we investigated the relationship between TyG index and acute coronary syndrome (ACS). Materials and Methods: Patients who were hospitalized in the coronary intensive care unit between January 2023–December 2024 were included in the study regardless of the admission diagnosis. ACS defined as ST elevation myocardial infarction (STEMI) and non-STEMI. The TyG index was calculated with the formula LN [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The relationship between the presence of acute coronary syndrome and troponin level was compared with the TyG index. Results: A total of 586 individuals, 353 (60.2%) males and 233 (39.8%) females, were included in this study. The mean TyG index value was calculated as 75 ± 0.31 (4.03–5.99). ACS was detected in 36.9% (n = 216) of the participants. The mean TyG index was higher in the group with ACS (4.92 ± 0.29) than in the group without ACS (4.65 ± 0.27), p < 0.001). Similarly, the mean value of triglyceride (171.58 ± 114.45 vs. 120.92 ± 63.02, CI 95%, p < 0.001) and glucose (133.57 ± 48.87 vs. 104.88 ± 34.76, CI 95%, p < 0.001) were also higher in the group with acute coronary syndrome. In logistic regression analysis, the TyG index was identified as the most significant predictor of ACS, associated with a 30.994-fold increase in ACS probability. Conclusions: This study demonstrated that the TyG index is a significant predictor of acute coronary syndrome independent of the hospitalization reason. The TyG index can be used as a valuable marker in clinical practice because it includes modifiable risk factors for coronary artery disease. Full article

Background/Objectives: Despite the common use of invasive diagnostics and treatment of coronary artery disease (CAD), there are still doubts concerning the disease management method of choice in the population of very old patients. Our goal was to assess the patient profile, feasibility of coronary angiography (CAG), effectiveness (successful relieving of the coronary artery’s narrowing or occlusion) of percutaneous coronary intervention (PCI) and safety (mortality and other complications) of both procedures in nonagenarians. Methods: The database of the Dr. E. Warmiński Clinical Hospital of the Bydgoszcz University of Technology was searched for patients aged 90 years and older who underwent CAG and PCI between 2013 and 2023. We retrospectively analysed the case reports of these patients, including reason for hospital admission, course of hospitalisation, procedure data, and complications. Results: A total of 150 nonagenarians meeting the criteria were found, with a mean age of 92 years and 63% being female. A total of 110 patients (73%) were admitted on the basis of acute coronary syndrome (ACS). Upon CAG, 108 patients had obstructive coronary artery disease confirmed, 90% of whom had multivessel disease. In 96 out of 108 of these patients (that is, 89%), PCI was performed successfully in 89 (93%) procedures. Transradial access was used in 112 patients (75%). According to the diagnosis, PCI was performed in all cases (100%) of STEMI patients, in 80% cases of non-ST elevation acute coronary syndrome (NSTE-ACS) patients, and in 27% cases of stable CAD patients. Median time of hospitalisation was 6.5 days (IQR 4–10). In the course of hospitalisation, mortality was 8.7% (13 out of 150), although two cases were non-cardiological in nature. In the PCI group, mortality was 11.5% (11 out of 96); all 11 were treated due to ACS (no deaths in patients with stable ACS). In the STEMI subgroup, mortality was much higher at 33% (4 out of 12, with all 4 admitted with cardiogenic shock). Accordingly, in the NSTEMI group, mortality was 8.97%. Other complications in the PCI group were perforation of coronary artery in 1 case, access site complications in the case of transfemoral access in 10 patients, bleeding requiring transfusion in 2 patients, and contrast-induced nephropathy (CIN) in 4 patients. Conclusions: This analysis demonstrates that the CAG and PCI procedures are feasible and effective in nonagenarians, and the risk of complications is not as great as it was heretofore believed. Full article

Background/Objectives: Current guidelines do not specifically address the use of P2Y12 inhibitor (P2Y12i) pretreatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who are expected to undergo a late invasive strategy. Nevertheless, such pretreatment may be considered in patients without a high bleeding risk (Class of Recommendation, IIb; Level of Evidence, C). Despite this ambiguity, P2Y12i pretreatment remains a common clinical practice. The present study aimed to evaluate the in-hospital prognostic impact of P2Y12i treatment prior to coronary angiography (CAG) in NSTE-ACS patients undergoing a late invasive strategy (CAG > 24 h after hospital admission). Methods: A retrospective analysis was conducted on NSTE-ACS patients undergoing a late invasive strategy included in the Portuguese Registry on Acute Coronary Syndromes between 2010 and 2023. The primary endpoint was a composite of in-hospital events, including all-cause mortality, non-fatal re-infarction, non-fatal stroke, and heart failure (HF). Secondary endpoints included the individual components of the primary endpoint and major bleeding (BARC types 3 and 4). Results: A total of 3776 patients were included (mean age, 66 ± 12 yrs; 29% female), of whom 1530 (41%) received P2Y12i pretreatment (group 1). Group 1 had a lower prevalence of prior myocardial infarction (16% vs. 21%) and prior percutaneous coronary intervention (12% vs. 15%) (both p ≤ 0.001). Although obstructive coronary artery disease was more frequent in group 1 (84% vs. 77%, p < 0.001), the presence of multivessel disease did not differ (52% vs. 52%, p = 0.667). Considering in-hospital antithrombotic therapy, group 1 had higher prescriptions of clopidogrel (68% vs. 56%), aspirin (99% vs. 81%), unfractionated heparin (21% vs. 8%), and enoxaparin (80% vs. 56%) (all p < 0.001). There was no significant difference in the primary composite endpoint between groups (9% vs. 9%, p = 0.906). Similarly, the secondary endpoints of all-cause mortality (0.6% vs. 0.7%), re-infarction (1.3% vs. 0.7%), stroke (0.7% vs. 0.4%), and HF (7% vs. 8%) did not differ significantly between groups (all p > 0.05). Nevertheless, group 1 exhibited higher rates of major bleeding (0.8 vs. 0.2%, OR 3.48, CI 95% 1.22–9.89, p = 0.013). Conclusions: Pretreatment with a P2Y12i in NSTE-ACS patients undergoing a late invasive strategy was not associated with reduction in the primary endpoint, although it was associated with higher rates of major bleeding. Full article

Background: Cardiovascular diseases (CVDs) are the leading global cause of death, responsible for 17.9 million deaths annually (32%) as of 2019. Acute coronary syndrome (ACS) significantly contributes to this burden, particularly in low- and middle-income countries. In Latin America, ACS accounts for 35% of deaths. In Ecuador, 36,058 deaths were reported between 2019 and 2021, underscoring its significant public health impact. Objectives: This study aimed to determine the epidemiological, clinical, and hospital management characteristics of ACS patients admitted to the Metropolitan Hospital of Quito, located at high altitude, from January 2021 to October 2023. Methodology: A retrospective observational study analyzed anonymized medical records of 133 ACS patients treated at a tertiary care hospital in Quito. Results: Among 133 ACS patients, 72.9% were male, with a mean age of 68.9 ± 13.9 years. Overweight was prevalent, with a mean BMI of 26.6 ± 3.0 kg/m². Hypertension (51.9%) and type 2 diabetes mellitus (26.3%) were common comorbidities. ST-segment elevation myocardial infarction (STEMI) was the most frequent ACS type (48.9%), followed by non-ST-segment elevation myocardial infarction (NSTEMI) (33.8%). Most patients (72.2%) underwent stent placement. Mortality was low (2.3%) and significantly associated with the presence of immunologic diseases (p = 0.015), TIMI risk score Grade IV (p = 0.009), and cardiac arrest on admission (p < 0.001). Conclusions: This study provides critical insights into the epidemiology and management of ACS in a high-altitude urban setting, emphasizing the importance of timely diagnosis and evidence-based therapies in improving patient outcomes. Full article

Introduction: Coronary artery disease remains one of the most prevalent causes of hospital cardiac arrest (OHCA). Although the benefit of early coronary angiography is well stablished in patients with ST-segment elevation, the benefit and the timing of performing it in other patients remain a matter of debate. This is due to the difficulty of identifying those in which an infarction with non-ST-segment elevation is the cause of the OHCA. Coronary artery calcium (CAC) emerges as a reliable predictor of coronary disease and adverse cardiovascular events, detectable even in non-gated chest computed tomography (CT) scans commonly used in OHCA etiological studies, showcasing potential for streamlined risk assessment and management. Aim: The aim of this study was to evaluate if CAC in non-gated CT scans performed in OHCA survivors could act as a good predictor of coronary artery disease on coronary angiography. Methods: This is a single-center, retrospective study of OHCA survivors without ST-segment elevation at presentation. We selected patients for whom a non-gated chest CT was performed and underwent coronary angiography due to the clinical, electrocardiogram (ECG), or echocardiographic suspicion of acute coronary syndrome. An investigator, blinded to the coronary angiography report, evaluated CAC both quantitively (with Agatston score) and qualitatively (visual assessment: absent, mild, moderate, or severe). Results: A total of 44 consecutive patients were included: 70% male, mean age of 60 ± 13 years old. The mean Agatston score was 396 ± 573 AU (Agatston units). Regarding the qualitative assessment, CAC was classified as mild, moderate, and severe in 11%, 25%, and 20% of patients, respectively. The coronary angiography revealed significant coronary lesions in 15 patients (34%), of which 87% were revascularized (80% underwent PCI and 7% CABG). The quantitative CAC assessment accurately predicted the presence of significant lesions on coronary angiography (AUC = 0.90, 95% CI 0.81–0.99, p < 0.001). The presence of moderate or severe CAC by visual assessment also predicted significant lesions on coronary angiography (OR 2.66, 95% CI 1.87–109.71, p = 0.01). There was also a good and significant correlation between the vessel with severe calcification in the CT scan and the culprit vessel evaluated by coronary angiography. CAC was reported in only 16% of the reviewed CTs, most of them with severe calcification. Conclusion: The assessment of CAC in non-gated chest CT scans proved to be feasible and displayed a robust correlation with the presence, severity, and location of coronary artery disease. Its routine use upfront was shown to be an important complement to CT scan reports, ensuring more precise and personalized OHCA management. Full article

Background: In Italy, workplace safety regulations require the training of first-aid officers to manage medical emergencies, including acute coronary syndromes. Although clinical guidelines recommend the early use of acetylsalicylic acid in myocardial infarction, little is known about the implementation of this recommendation in practice. This study aims to assess the use of acetylsalicylic acid for ST-elevation myocardial infarction (STEMI) in workplace and non-workplace settings, with a focus on informing the evaluation and improvement of first-aid training programs and emergency response protocols. Methods: We conducted a retrospective, observational cohort study using 2019 data from the Regional Agency for Emergency Urgency. Cases were identified and stratified by event location (workplace vs non-workplace), to analyze patterns of acetylsalicylic acid administration. A logic model has been developed to program a stepwise plan of action for policies development. Results: A total of 2174 STEMI cases were identified, of which 380 (17.5%) occurred in the workplace. Workplace cases were younger and more likely to be male. Acetylsalicylic acid was administered in only 31 cases overall, with no statistically significant difference between settings. This assessment advocates for the implementation of targeted actions, which may include updates to current legislation and policies. Conclusions: These findings highlight an urgent need to systematically evaluate existing workplace first-aid training and emergency protocols. Integrating modules on acetylsalicylic acid administration into training curricula, along with performance monitoring mechanisms, may significantly enhance early STEMI management and patient outcomes. Updating safety programs to align with evidence-based practices should follow a structured approach. Full article

Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) often coexists with multivessel coronary artery disease (MVD), complicating treatment decisions. Current guidelines suggest complete revascularization (CR), yet robust evidence in hemodynamically stable patients remains insufficient. However, the comparative benefit of CR over incomplete revascularization (IR) in reducing ischemic events and improving cardiac function in this population is not well established. The aim of this study was to evaluate the impact of CR on all-cause mortality, cardiac death, and ischemic readmissions at 6 and 12 months, as the composite primary outcome, and to assess left ventricular ejection fraction (LVEF) improvement at discharge and hospital length of stay, as secondary outcomes. A total of 282 hemodynamically stable NSTE-ACS patients with MVD were included, of whom 218 (77.3%) underwent CR and 64 (22.7%) IR. The primary composite outcome occurred in 40.6% of IR patients versus 11.0% in the CR group at 6 months (p < 0.001), and 68.8% vs. 22.0% at 12 months (p < 0.001). CR was associated with significantly lower rates of all-cause and cardiac death, myocardial infarction, and unstable angina. Stroke incidence was similar. Event-free survival favored CR. Multivariable analysis identified CR and baseline LVEF as independent predictors of 12-month outcomes (HR for CR: 7.797; 95% CI: 3.961–15.348; p < 0.001; HR for LVEF: 0.959; CI: 0.926–0.994; p = 0.021). These findings strongly support CR as the preferred therapeutic strategy. Future prospective randomized studies are warranted to confirm the results. Full article

Background and Objectives: In vivo data on healed coronary plaques (HCPs), the hallmark of previous plaque disruption, remains scarce. The study aimed to use optical coherence tomography (OCT) imaging to assess the prevalence, morphological features, and clinical significance of culprit HCPs in patients with acute coronary syndrome (ACS). Materials and Methods: A total of 87 ACS patients (74.3% non-ST-segment elevation ACS) who underwent pre-procedural OCT imaging of the culprit vessel at a single center were retrospectively analyzed. A pilot subgroup of patients with intracoronary thrombi at the culprit site, in various stages of organization and healing, enabled a detailed morphological characterization of HCP despite the absence of histological validation. Three distinct HCP imaging aspects were identified: type I—overlaying fibrous tissue, type II—overlaying lipid tissue, and type III—overlaying calcific tissue. HCP presence was subsequently assessed in the entire population. Clinical correlations included associations with post-stenting outcomes, particularly edge dissections (ED). Results: Culprit HCPs were identified in 78 patients (89.7%): type I—30.8%, type II—51.3%, and type III—17.9%. Regarding the underlying substrate and complication mechanism, type I HCP was associated with pathological intimal thickening (70.8%) and plaque erosion (75%), type II with lipid-rich plaque (80%) and plaque rupture (PR) (82.5%), and type III correlated with calcific plaque (92.9%, p < 0.0001) and both PR and calcified nodule (p < 0.0001). A unique signal-rich ring was observed at the HCP–tissue interface in both type II (77.5%) and type III (78.6%, p < 0.0001). There was a significant correlation between stent ED and HCP presence at landing zones (LZ) (HR 4.14, 95% CI: 1.79–9.55; p < 0.001). Conclusions: OCT analysis of intracoronary organizing fresh thrombi allowed detailed characterization of culprit HCPs and in vivo classification into three imaging types. This approach likely contributed to the high observed detection rate of HCP by enhancing recognition of subtle OCT features. HCP may create mechanical vulnerability if located at the stent LZ. Our improved HCP detection techniques may help optimize stent-related outcomes of OCT-guided procedures by choosing an HCP-free LZ or longer stents. Full article

Background/Objectives: Inflammation plays a key role in acute coronary syndromes (ACS). The systemic immune-inflammation index (SII), which integrates immune and inflammatory markers, may serve as a valuable prognostic tool. This study aimed to evaluate the utility of SII as a short-term predictor of mortality and major adverse cardiovascular and cerebral events (MACCE) in ACS patients. Methods: A retrospective analysis was conducted on 964 ACS patients admitted in 2023. SII was calculated from admission hematological parameters. Primary and secondary outcomes were 30-day mortality and MACCE, respectively. Results: SII levels differed significantly across ACS subtypes (p < 0.001), highest in ST-segment elevation myocardial infarction (STEMI) and lowest in unstable angina. SII was markedly higher in deceased patients (2003.79 ± 1601.17) vs. survivors (722.04 ± 837.25; p < 0.001) and remained an independent predictor of mortality (OR = 1.038, p < 0.001). Similarly, SII was elevated in MACCE cases (1717 ± 1611.32) vs. non-MACCE (664.68 ± 713.11; p < 0.001) and remained predictive in multivariate analysis (OR = 1.080, p < 0.001). Predictive accuracy for MACCE was moderate (AUC = 0.762), improved when combined with GRACE 2, especially in specificity (p = 0.07). In STEMI, SII had excellent accuracy (AUC = 0.874), outperforming neutrophil–lymphocyte ratio and C-reactive protein. SII rose at 24 h and declined at 48 h in STEMI, with a slower decline in MACCE patients. Conclusions: SII proved to be a cost-effective biomarker reflecting inflammation, immunity, and thrombosis. Elevated SII predicted short-term MACCE and mortality in ACS, with improved prognostic power when combined with GRACE 2. Persistent elevation may signal ongoing inflammation and increased MACCE risk. Full article

Objectives: This study aimed to evaluate the ability of three-dimensional (3D) speckle tracking echocardiography (STE) to detect acute coronary occlusions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and its potential diagnostic advantage over two-dimensional (2D) STE. Methods: Fifty-six patients with NSTE-ACS (mean age 64 ± 11 years; 80% male) underwent 2D and 3D transthoracic echocardiography prior to coronary angiography. Global longitudinal strain (GLS), global circumferential strain (GCS), and 3D ejection fraction (EF) were analyzed. Acute coronary occlusion was defined as TIMI flow 0–1 in the presumed culprit artery. Results: Acute coronary occlusion was present in 16 patients (29%). Patients with occlusion had significantly more impaired strain compared to those without: 3D GLS (−12.5 ± 2.7% vs. −15.5 ± 2.1%, p < 0.001), 2D GLS (−12.6 ± 2.8% vs. −15.6 ± 2.0%, p < 0.001), 3D GCS (−24.8 ± 4.4% vs. −27.8 ± 4.3%, p = 0.02), and 2D GCS (−18.1 ± 5.5% vs. −22.9 ± 4.7%, p = 0.002). In contrast, 3D EF did not differ significantly between groups (52.5 ± 4.7% vs. 54.7 ± 5.7%, p = 0.16). Receiver operating characteristic analysis showed that 3D and 2D GLS had the highest diagnostic performance (AUCs 0.81 and 0.78), while 3D EF had the lowest (AUC 0.61). Feasibility was lower for 3D STE (86%) than for 2D longitudinal strain (95%, p = 0.03). Conclusions: Both 3D and 2D GLS showed higher diagnostic accuracy than 3D EF in identifying acute coronary occlusion in NSTE-ACS patients. While 3D STE enables simultaneous assessment of multiple parameters, it did not offer incremental diagnostic value over 2D STE and had lower feasibility. Full article

Background: Coronary artery disease (CAD) is a leading global cause of mortality. The role of calcium (Ca), a key metabolic and structural element, in atherosclerosis and inflammation remains unclear. Ca influences immune cell function and is a component of atherosclerotic plaques. Hair analysis reflects long-term mineral exposure and may serve as a non-invasive biomarker. Objectives: This pilot study aimed to investigate the association between hair Ca levels and acute coronary syndrome (ACS), and to evaluate correlations with the Systemic Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI), and selected CAD risk factors. Methods: Ca levels were measured in hair samples from patients undergoing coronary angiography for suspected myocardial infarction. Associations with ACS diagnosis, Syntax score, SII, SIRI, and CVD risk factors were analyzed. Results: Serum calcium levels were not significantly associated with the presence of acute coronary syndrome (ACS) (p = 0.392) or with its clinical subtypes, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) (p = 0.225). Diagnosis of ACS was linked to higher SII (p = 0.028) but not SIRI (p = 0.779). Ca levels correlated negatively with Syntax score (R = −0.19, p = 0.035) and SII (R = −0.22, p = 0.021) and positively with HDL-C (R = 0.18, p = 0.046). Conclusions: Hair calcium content may reflect subclinical inflammation and CAD severity. Although no direct link to ACS was observed, the associations with SII, HDL-C, and Syntax score suggest a potential diagnostic role which should be further explored in larger, well-controlled studies. Full article