Search Results (1,223)

Background: Coronary computed tomography angiography (CCTA) is a well-established key diagnostic modality for ruling out obstructive coronary artery disease (CAD) in patients with suspected chronic coronary syndromes (CCSs) and low to intermediate pre-test probability. The widespread availability of preprocedural CCTA data in CCS patients undergoing percutaneous coronary intervention (PCI), however, creates a new opportunity for image-guided procedural planning. Objective: The PRECISION-CT study (Prospective Evaluation of Coronary CTA Integration for Strategy Improvement and Optimization of Non-Emergent PCI) aims to evaluate the impact of CCTA-guided PCI on patient safety and clinical outcomes. Methods: PRECISION-CT is a prospective, two-center, randomized controlled trial, enrolling patients with CCS scheduled for elective PCI due to obstructive CAD by CCTA. Patients are randomized 1:1 to either CCTA-guided PCI or standard angiography-guided PCI. In patients randomized to CCTA-guided PCI, advanced post-processing of CCTA datasets provides specific procedural planning recommendations based on the detailed assessment of coronary artery takeoff, lesion location and plaque characteristics. In addition, real-time integration of the advanced CCTA post-processing is available in the catheterization laboratory during the PCI procedure. Patients randomized to angiography-guided PCI are treated according to routine clinical practice. Results: The primary endpoint is a composite procedural safety and efficacy score including: (i) need for intravascular imaging, (ii) procedural complications, (iii) post-procedural high-sensitivity troponin T elevation, (iv) contrast media, (v) radiation exposure, and (vi) length of hospital stay. Secondary endpoints include major cardiac adverse events such as cardiac death, non-fatal myocardial infarction, target-lesion reintervention and probable or definitive stent thrombosis during 1 year of follow-up. Conclusions: The PRECISION-CT study will provide pragmatic evidence on the ability of CT-guided PCI in patients with CCS to optimize procedural outcomes. These findings may help inform the broader adoption of image-guided precision revascularization strategies in interventional cardiology. Full article

Obstructive sleep apnea syndrome (OSA) is increasingly recognized as a common and clinically relevant comorbidity in coronary artery disease (CAD). Epidemiological studies demonstrate that OSA is highly prevalent among patients with CAD and independently increases the risk of myocardial infarction, accelerated atherosclerosis, and recurrent adverse events. The pathophysiological mechanisms underlying this association include intermittent hypoxia, sympathetic overactivation, oxidative stress, endothelial dysfunction, systemic inflammation, metabolic dysregulation, and pro-prothrombotic changes. These processes converge to promote coronary plaque formation, instability, and ischemia. Clinical evidence indicates that OSA contributes to silent nocturnal ischemia, higher rates of acute coronary syndromes, restenosis after percutaneous coronary intervention, and worse prognosis following myocardial infarction or surgical revascularization. Continuous positive airway pressure (CPAP) therapy improves blood pressure, endothelial function, and surrogate markers of ischemia, but large randomized trials have yielded neutral results on major cardiovascular events, largely due to suboptimal adherence. However, observational studies, however, suggest improved survival in patients who are adherent to CPAP therapy. Lifestyle interventions, particularly weight reduction, remain essential adjunctive strategies. This review synthesizes current evidence, evaluates therapeutic implications, and highlights the need for systematic OSA screening in CAD populations. Future research should focus on patient phenotyping, treatment adherence, and integrated care models to improve cardiovascular outcomes. Full article

Accurate assessment of the functional significance of coronary artery stenoses is essential for guiding revascularization decisions and improving clinical outcomes in patients with coronary artery disease (CAD). While invasive wire-based fractional flow reserve (FFR) remains the gold standard for physiological lesion assessment, its adoption in routine clinical practice is limited by procedural complexity, patient discomfort, time consumption, and cost. These limitations have driven the development of angiography-derived FFR techniques that enable physiological evaluation without pressure wires or pharmacologic hyperaemia. Recent advances in computational modelling, artificial intelligence, and image processing have facilitated the estimation of FFR from conventional coronary angiography, including approaches that require only a single angiographic view. Single-view angiography-derived FFR methods—such as Murray law-based quantitative flow ratio (µQFR), FFR2D, Angio-iFR/FFR, sAccuFFR, and X1-FFR—aim to simplify workflow while maintaining diagnostic accuracy. Among these, µQFR has demonstrated the most consistent validation against invasive FFR across a broad range of clinical scenarios, including complex lesions, severe aortic stenosis, multivessel disease, and acute coronary syndromes. This review summarizes the principles, validation data, clinical applications, and limitations of single-view angiography-derived FFR technologies and highlights their potential to expand the adoption of physiology-guided coronary intervention. Full article

Background/Objectives: Hyperspectral imaging (HSI) facilitates noninvasive assessment of tissue perfusion in patients with peripheral arterial disease. However, available studies are either based on small cohorts and provide no comparison to standard methods or only one-time measurements. Methods: In this prospective cohort study, assessment of tissue perfusion with transcutaneous oxygen pressure (TcPO2) measurement and HSI before (1 day) and after revascularization (1–3 days) in patients with Rutherford category 3–6 was performed. The primary endpoint was change in tissue perfusion evaluated with the different methods. HSI and TcPO2 were correlated with clinical improvement after revascularization. Results: Significant improvement in the perfusion was detected by tissue oxygenation in the microcirculation (StO2; improvement +12%, mean difference 5 ± 15.9, p < 0.001) and near-infrared spectroscopy (NIR; improvement +9%, mean difference 3.7 ± 7.1, p < 0.001), but not with the tissue hemoglobin index (THI; mean difference +0.8 ± 10.3, p = 0.428). A high number of worse or unchanged HSI measurements despite successful revascularization was detected. A significant improvement of TcPO2 after revascularization (mean difference +16.2 ± 27.7 mmHg, p < 0.001), consistent with clinical improvement, was detected. No correlation of the HSI parameters with TcPO2 or clinical symptoms could be seen. Conclusions: Significant improvement of StO2, NIR and TcPO2 values was detected after successful revascularization; however, no correlation of HSI parameters with TcPO2 or clinical results could be observed. Furthermore, the substantial rate of lower or unchanged HSI parameters despite clinical improvement and higher TcPO2 values calls the validity and clinical relevance of TIVITA^®-based HSI measurements for postoperative tissue perfusion improvement into question. Full article

Background: The number of patients with chronic coronary syndromes (CCS) is growing, influenced by factors such as increasing life expectancy and prevalence of risk factors. Thus, cardiovascular (CV) disease remains the leading cause of mortality and morbidity worldwide. The main objective of the study was to identify factors associated with long-term survival in patients with chronic coronary syndrome, with a focus on kidney function described by eGFR and albuminuria (assessed by uACR). Methods: The study comprised a total of 257 patients from Bialystok (Poland), aged ≤ 80 years, who 6–18 months earlier were hospitalized for acute coronary syndrome or elective myocardial revascularization. During the 80-month follow-up, 40 (15.6%) patients died, while there was no information about three (1.2%) patients. Patients with preserved eGFR and without albuminuria were characterized by the longest survival, with deterioration of prognosis in groups of progressive kidney dysfunction as defined by KDIGO based on eGFR and uACR. The primary endpoint was death from any cause. Results: Those who survived the 80-month follow-up period were younger (p < 0.001), had a lower waist circumference (p = 0.028), higher diastolic blood pressure (p = 0.026), lower NTproBNP (p < 0.001) and hsCRP (p = 0.001) concentrations, reduced eGFR (p = 0.004) and increased ACR (p = 0.023) were strongly associated with mortality. In logistic regression analysis with stepwise elimination of variables, the strongest factors affecting survival were hemoglobin concentration, left ventricle ejection fraction (LVEF) and hsCRP. Conclusions: Measurement of albuminuria, in addition to eGFR, allows patients to be correctly classified into CV risk categories and facilitates appropriate treatment of patients with CCS. Higher diastolic blood pressure (but still within normal range) was found in patients who later survived 6 years. Measurements of hsCRP, hemoglobin concentration and LVEF help to identify CCS patients at the highest risk of mortality in long-term follow-up. Full article

Cardiogenic shock (CS) remains a life-threatening syndrome characterized by reduced cardiac output and end-organ hypoperfusion, most commonly resulting from acute myocardial infarction (AMI). Despite advances in early revascularization and increasing use of percutaneous mechanical circulatory support (MCS), short-term mortality in AMI-related CS (AMI-CS) remains high. This review summarizes the contemporary evidence on short-term percutaneous MCS in AMI-CS, with a focus on intra-aortic balloon pump (IABP), Impella microaxial flow pumps, and venoarterial extracorporeal membrane oxygenation (VA-ECMO), and provides insights into device selection and implementation in clinical practice. We performed a comprehensive analysis of the most relevant randomized controlled trials and key guideline recommendations from European and North American societies concerning the use of MCS. Despite its long-standing, IABP has not demonstrated a mortality benefit in contemporary trials and is no longer recommended for routine use in AMI-CS without mechanical complications. Nevertheless, it remains widely used due to its simplicity, safety profile, and broad availability. In contrast, Impella devices provide active left ventricular unloading and have shown promising hemodynamic effects, with the DanGer Shock trial suggesting a potential survival benefit in carefully selected patients, at the expense of higher complication rates. VA-ECMO offers full cardiopulmonary support but is associated with the highest complication rates and increases left ventricular afterload, often requiring adjunctive unloading with devices such as Impella (ECPELLA). However, recent randomized trials have not demonstrated a clear survival advantage for VA-ECMO, and concerns regarding its complications persist. In conclusion, CS continues to pose major therapeutic challenges, and no single MCS device has consistently shown a survival benefit across all AMI-CS patient populations. Individualized, phenotype-driven strategies that incorporate hemodynamic profiling and timely escalation of support are essential. Further randomized studies are urgently needed to define optimal device selection, the timing of placement, and appropriate patient selection criteria. Institutional protocols guided by clinical stage, etiology, and available expertise will be pivotal in improving outcomes. Full article

Background/Objectives: Intermediate coronary artery stenosis is difficult to risk-stratify, as stenosis severity alone often fails to predict events. This study aimed to evaluate whether quantitative CCTA-derived plaque characteristics and lesion morphology are associated with MACE during long-term follow-up. Methods: In this single-center prospective study, 128 patients with stable angina symptoms underwent standardized CCTA and were diagnosed with at least one intermediate coronary stenosis (50–69%, CAD-RADS 3). Quantitative parameters of lesion morphology, lumen geometry, vessel wall dimensions, and plaque composition were assessed using semi-automated CCTA adapted plaque analysis (QAngio CT). Patients were followed for a median of 72 months. MACE was defined as a composite outcome of all-cause mortality, target lesion revascularization, non-fatal MI, and stroke. Results: During follow-up, 26.6% of patients experienced MACE. High-risk plaque features were more frequent in patients with MACE. Lesions associated with MACE demonstrated significantly smaller lumen area, reduced mean lumen diameter, and decreased vessel wall area at the obstruction site. In addition, plaques leading to adverse events exhibited larger necrotic core areas. Although no single quantitative parameter independently predicted MACE, a combined multivariable model incorporating lumen geometry and plaque composition showed significant prognostic value. Conclusions: In patients with intermediate coronary stenosis, lesion-specific quantitative CCTA parameters—particularly luminal geometry and necrotic core extent—provide prognostic information beyond traditional plaque burden and stenosis assessment. Incorporating detailed plaque morphology into routine CCTA evaluation may improve long-term risk stratification and support more individualized clinical management. Full article

Purpose: The aim of this narrative review is to update current knowledge on Moyamoya vasculopathy (MMV) by addressing key diagnostic debates—including laterality; genetic subtypes; regional epidemiology; and features distinguishing Moyamoya Disease (MMD), Moyamoya Syndrome (MMS) and their mimics. Methods: Key and representative studies were identified through PubMed/MEDLINE and Scopus, focusing on publications from 2014–2025 while also considering earlier seminal works. Results: MMD typically presents with bilateral steno-occlusion of the terminal internal carotid arteries (ICAs) and proximal middle and anterior cerebral arteries (MCAs/ACAs) due to concentric vascular thickening, accompanied by characteristic ‘puff-of-smoke’ collaterals, whereas MMS shows a similar but more often unilateral pattern with fewer collaterals, influenced by the underlying condition. However, this distinction often fails to reflect the full clinical and radiological variability of the Moyamoya spectrum. Atypical moyamoya-like patterns, often confined to M1 or A1 segments, further complicate diagnosis. Clinical manifestations ranged from asymptomatic cases to ischemic or hemorrhagic strokes, and occasionally seizures. Diagnosis relied on multimodal imaging (DSA, MRA, CTA), but genetic mutations, contributing to radiological variability, often complicate differentiation between MMD, MMS, and mimics. Management is pattern-specific: MMS and atypical forms are generally managed conservatively, whereas MMD frequently requires surgical revascularization, particularly in children and symptomatic adults. Nevertheless, variability within diagnostic categories limits the applicability of rigid treatment protocols. Conclusions: Current diagnostic algorithms remain limited. Integrating advanced imaging findings with clinical, genetic, and epidemiological data is essential to define the full disease spectrum, improve diagnostic accuracy, and inform patient management and outcome assessment. Full article

(1) Background: Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is a complex, high-risk procedure compared to standard percutaneous coronary intervention (PCI). Scoring systems such as the Japanese Chronic Total Occlusion (J-CTO), European Chronic Total Occlusion (EuroCTO), and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) evaluate lesion difficulty and predict outcomes. Nutritional status, measured by the Prognostic Nutritional Index (PNI), may also affect procedural success and long-term survival. The objective of this study was to evaluate the combined impact of procedural complexity and nutritional status on the clinical outcomes of patients undergoing CTO-PCI. (2) Methods: We analyzed 118 patients undergoing CTO-PCI between May 2021 and March 2022. Procedural complexity was assessed using the J-CTO, EuroCTO, and PROGRESS-CTO scores, while nutritional status was evaluated using the PNI. Primary outcomes included all-cause mortality and repeat revascularization, which were analyzed using Cox proportional hazards regression and Kaplan–Meier survival analyses. (3) Results: Adverse outcomes occurred in 25 patients (mortality: 17; revascularization: 8). Patients with adverse outcomes had significantly lower left ventricular ejection fraction (LVEF) (46 ± 13.7% vs. 52.1 ± 10.5%, p < 0.001), lower PNI (p < 0.001), and higher J-CTO, EuroCTO, and PROGRESS-CTO scores (all p < 0.05). A PNI cut-off value of 46 predicted mortality with a sensitivity of 70.6% and specificity of 75.2% (area under the curve [AUC] = 0.739, p = 0.001). Multivariable analysis identified LVEF (hazard ratio [HR] 0.966, p = 0.036), J-CTO score (HR 1.598, p = 0.027), and PNI (HR 0.925, p = 0.022) as independent predictors of mortality. (4) Conclusion: Both procedural complexity and nutritional status significantly influence outcomes following CTO-PCI. Incorporating PNI together with procedural complexity scores into pre-procedural assessments may enhance risk stratification and optimize patient management. Full article

Background: Cardiovascular disease (CVD), including myocardial ischemia, remains the leading cause of mortality. Current therapies for ischemic myocardium rely largely on invasive revascularization strategies, highlighting the need for improved non-invasive diagnostic and therapeutic approaches. Recent studies suggest that extracellular vesicles (EVs) play a critical role in cardiovascular pathophysiology and may offer novel clinical applications. Methods: This review synthesizes current preclinical and clinical literature on EV biology, including their classification, isolation, and characterization methods, and mechanisms of Intercellular communication. Published studies evaluating EVs as biomarkers and non-surgical therapeutics across major cardiovascular conditions were critically analyzed. Results: EVs facilitate intercellular communication by transferring bioactive molecules that influence disease progression and cardiac repair. Accumulating evidence supports their potential utility as biomarkers for disease prediction and severity assessment, as well as cell-free therapeutics in myocardial infarction, cardiomyopathies, atrial fibrillation, and heart failure. However, significant gaps remain, including the lack of validated EV-based biomarkers, inconsistent isolation and characterization methodologies, limited in vivo tracking data, and barriers to clinical translation. Conclusions: EVs represent a promising frontier in non-invasive cardiovascular diagnostics and therapeutics. Addressing current methodological and translational challenges, alongside advances in EV bioengineering, will be essential to realize their full clinical potential in CVD management. Full article

Background: The purpose of this study was to compare the prognostic value of Controlling Nutritional Status (CONUT) and Prognostic Nutritional Index (PNI) scores for predicting in-hospital mortality among patients who presented with ST-segment elevation myocardial infarction (STEMI) and received primary percutaneous coronary intervention (P-PCI). Methods: This retrospective cohort study comprised 4599 STEMI patients who received P-PCI. The primary outcome was described as in-hospital mortality. Multivariable logistic regression analysis was performed to determine the association between in-hospital mortality and CONUT and PNI scores. Model performance and goodness-of-fit measures were used for comparison. Results: In-hospital mortality rate was 5.7% (n = 261). Patients who died during the index hospitalization were older and more likely to have diabetes, prior myocardial infarction (MI), revascularization history, longer total ischemic time, no-reflow and reduced left ventricular ejection fraction (LVEF). According to body mass index (BMI) categories, moderate-to-severe malnutrition was observed in approximately 17–21% and 8–10% of patients according to the CONUT and PNI scores, respectively. Both CONUT and PNI scores were significantly associated with in-hospital mortality. However, the model incorporating CONUT demonstrated superior goodness of fit and higher discriminative performance compared with the model incorporating PNI. Conclusions: Among patients with STEMI, moderate-severe malnutrition was present in nearly 10% and 20% when evaluated using PNI and CONUT, respectively. The CONUT score demonstrated superior predictive performance for in-hospital mortality compared with PNI. Full article

Background and Objectives: The regeneration of the pulp–dentin complex represents an alternative to conventional root canal treatment, aiming to preserve tooth biology and function. Cell-free regenerative endodontic therapy (CF-RET) exploits endogenous stem cells from the periapical region without ex vivo cell manipulation. Despite growing interest, the biological mechanisms, clinical indications, and predictability of CF-RET remain not clearly defined. This structured narrative review aimed to update a previous review by analyzing recent human studies on CF-RET. Materials and Methods: This review was conducted using the PRISMA 2020 guidelines to guide transparent reporting of the literature search and study selection process and was registered in PROSPERO (CRD420251075131). In vitro and in vivo human studies published between January 2017 and December 2024 investigating CF-RET were included, while studies involving cell transplantation, non-human models, case reports, and reviews were excluded. Study selection, data extraction, and quality assessment using the QuADS tool were performed, and the evidence was synthesized using a qualitative narrative approach. Results: Sixty-four studies were included. In vitro studies reported favorable effects of growth factors, exosomes, and biomimetic scaffolds on stem cell viability, migration, proliferation, odontogenic differentiation, and angiogenesis, while neurogenic differentiation was less consistently investigated. Scaffold composition, microstructure, and rheological properties were also considered. In vivo studies mainly focused on immature teeth with incomplete root development and demonstrated positive clinical and radiographic outcomes, including root development and canal diameter reduction. Conclusions: The current evidence supports the biological potential of CF-RET as a regenerative approach; however, substantial heterogeneity, the limited number of clinical studies and the absence of standardized protocols preclude definitive conclusions, highlighting the need for further well-designed translational and clinical investigations considering clinical applicability. Full article

Objective: This study aimed to compare thromboangiitis obliterans (TAO) and diabetic peripheral vascular disease (DPVD), the two major causes of distal limb ischemia, within a single analytical framework. The comparison was not limited to practical biomarkers that could support differential diagnosis but was based on multidimensional parameters that determine the clinical spectrum and prognosis. The two cohorts were systematically evaluated in terms of demographics and comorbidity burden, clinical presentation and limb involvement pattern, ulcer prevalence and localization, real-life treatment strategies (medical, endovascular, and surgical), and hard clinical endpoints (major/minor amputation, hospitalization, and all-cause mortality). DPVD was phenotyped according to the lesion level as isolated distal, isolated proximal, or multilevel. Within this framework, the isolated distal diabetic peripheral vascular disease (d-DPVD) subgroup was analyzed to determine how it differs from TAO in terms of clinical course, treatment patterns, and outcomes, despite the distal anatomical similarity. Methods: In this single-center retrospective cohort study, conducted between June 2019 and June 2025, 120 non-diabetic patients who met the angiographic TAO criteria were compared with 395 patients with DPVD with infrapopliteal/pedal atherosclerotic involvement. Clinical characteristics, ulcer topography, treatment strategies, and outcomes were recorded. The discriminatory value of the blood count and lipid-based inflammatory/atherogenic indices were evaluated using logistic regression and receiver operating characteristic (ROC) curve analyses. Additionally, a separate subgroup analysis was performed for the d-DPVD subgroup, which was considered the closest to the TAO phenotype in this study design. Results: Patients with DPVD were significantly older than those with TAO (61.1 ± 12.1 vs. 39.7 ± 7.9 years; p < 0.001), and male predominance was more pronounced in the TAO group (94.2% vs. 84.8%). Compared with TAO, DPVD was associated with a higher cardiometabolic comorbidity burden and increased inflammatory and atherogenic indices. Although the overall ulcer prevalence was comparable, DPVD more frequently presented with plantar or proximal ulcers confined to a single extremity, whereas TAO was characterized by bilateral or multi-extremity involvement and distal acral ulceration. Antiplatelet and statin therapy, revascularization, and rates of major amputation, all-cause mortality, and hospitalization were higher in patients with DPVD (all p < 0.05). On multivariate analysis, age, cumulative smoking exposure, SIRI, and CRI-I independently distinguished DPVD from TAO (all p < 0.05). In the isolated distal DPVD subgroup, despite similar distal anatomy, inflammatory/atherogenic burden, and overall clinical risk remained adverse. Conclusions: TAO and DPVD are two distinct phenotypes with different pathobiologies and prognoses, despite similar distal ischemia presentations. Simple inflammatory and atherogenic composite indices, evaluated in conjunction with clinical/ulcer patterns, may support the differential diagnosis and risk stratification of patients with peripheral arterial disease (PAD). However, prospective multicenter validation of these findings is required to confirm the results. Full article

Heart transplantation remains the definitive therapy for end-stage heart failure, but donor coronary artery disease (CAD) is a common reason for allograft refusal, limiting organ availability. We describe a case of orthotopic heart transplantation using a donor heart with isolated coronary artery disease managed with concurrent surgical revascularization. A 66-year-old male with end-stage non-ischemic cardiomyopathy requiring temporary mechanical circulatory support underwent heart transplantation using a donor allograft with a focal lesion in a large first diagonal artery. Following standard implantation, a left internal mammary artery–to–first diagonal artery bypass was performed prior to reperfusion. The patient was successfully weaned from cardiopulmonary bypass with improving left ventricular function and had an uncomplicated postoperative course aside from transient delirium and dysphagia. Echocardiography demonstrated recovery of normal left ventricular function, and the patient remained clinically well with preserved biventricular function at 7-month follow-up. This case demonstrates the feasibility of orthotopic heart transplantation with concurrent coronary artery bypass grafting using an arterial conduit and supports surgical optimization of select donor hearts, with focal coronary disease as a potential strategy to expand the donor pool without compromising short-term outcomes. Full article

Objectives: To assess the impact of peripheral artery disease (PAD) on the outcomes of patients admitted for infected diabetic foot attack (DFA). Methods: Retrospective observational study of consecutive patients admitted to a third-level multidisciplinary diabetic foot service in 2024 for diabetic foot ulcers (DFUs) complicated by moderate or severe infection. Based on the presence of PAD, patients were divided into two groups: those with neuro-ischemic DFA (PAD+), treated with prompt revascularization, and those with neuropathic DFA (PAD-). The following in-hospital outcomes were evaluated: minor and major amputations; length of stay (LOS); mortality. Once discharged, patients were regularly followed as outpatients, and their six-month outcomes (healing, major amputation, and mortality) were analyzed. Results: Overall, 119 patients were included (70% PAD+ vs. 30% PAD-). The mean age was 67 ± 13 years, most patients were male (75%) and had type 2 diabetes (92%) with a mean duration of 20 ± 12 years. In-hospital outcomes for the two groups (PAD+ vs. PAD-) were as follows: minor amputation (41.7 vs. 25.7%, p = 0.09); major amputation (2.4 vs. 2.9%, p = 0.8); LOS (21 ± 11 vs. 14 ± 11 days, p = 0.004); mortality (3.6 vs. 0%, p = 0.1). The six-month follow-up outcomes (PAD+ vs. PAD-) were as follows: healing (40.5 vs. 90.6%, p < 0.0001); major amputation (8.1 vs. 3.1%, p = 0.1); mortality (8.1 vs. 0%, p = 0.01). Additionally, PAD (OR 3.6, CI: 1.4–12.1, p = 0.001) was independently related to non-healing. Conclusions: In the context of infected DFA, PAD appeared to play a significant role only in hospitalization length, while having greater influence on mid-term outcomes at the six-month follow-up, particularly in reducing healing chances. Full article