Lipoprotein(a) [Lp(a)] is a causal risk factor for cardiovascular disease, and it is particularly associated with premature acute coronary syndrome (ACS). We investigated whether elevated Lp(a) can predict recurrent cardiovascular events in patients who experienced their first ACS less than or equal to 40 years of age. Within the STudy of eArly Myocardial INfArction registry, we recruited 405 consecutive patients who survived their first ACS less than or equal to 40 years of age; of them 378 had complete follow-up data. Clinical endpoint was the development of major adverse cardiovascular events (MACE; i.e. cardiac death, readmission for ACS or malignant ventricular arrhythmias, ischemic stroke, or coronary revascularization due to clinical deterioration). Multi-adjusted Cox regression was used to assess the association between Lp(a) and first recurrent MACE risk. Of the 378 ACS survivors (33.7 ± 4.3 years), 139 (36.8%) experienced a MACE over a median 8-year (5.2-12.5 years) follow-up. Elevated Lp(a) showed a borderline independent association with higher recurrent MACE [hazard ratio per 1 mg/dl: 1.004, 95% confidence interval (CI): 0.999-1.009, P = 0.051]. Moreover, patients with baseline Lp(a) levels greater than or equal to 50 mg/dl had 82.6% higher risk of MACE as compared with those below (hazard ratio 1.826, 95% CI: 1.141-2.925, P = 0.012); similarly, patients with Lp(a) ≥ 70 mg/dl had 118% higher risk as compared with those below (hazard ratio 2.180, 95% CI: 1.330-3.573, P = 0.002). Elevated Lp(a) concentrations demonstrate an independent association with recurrent MACE among very young ACS survivors. Until targeted Lp(a)-lowering treatments become clinically available, an aggressive lipid-lowering approach may be warranted to partially attenuate Lp(a)-related residual cardiovascular risk.

ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition needing urgent reperfusion, with better outcomes linked to optimal myocardial perfusion. Statins may reduce ischemia-reperfusion injury through pleiotropic effects. While the 2019 European Society of Cardiology (ESC) Dislipidemia Guidelines recommended high-intensity statins before percutaneous coronary intervention (PCI), this was not included in the 2023 ESC or 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS Guidelines. To evaluate the effect of high-dose statin loading before primary PCI in improving coronary reperfusion and clinical outcomes in STEMI patients through a systematic review and meta-analysis of randomized controlled trials (RCTs). On June 2025, CENTRAL, EMBASE, and PubMed were searched for RCTs comparing high-dose statin preloading with placebo or no statin in STEMI patients undergoing primary PCI. The primary outcome was post-PCI thrombolysis in myocardial infarction (TIMI) flow grade 3. Secondary outcomes included all-cause mortality and greater than or equal to 50% ST-segment resolution. Data were pooled using random-effects models, reporting odds ratios (OR) with 95% confidence intervals (CIs). Nine RCTs with 1862 patients were included. High-dose statin preloading significantly increased the likelihood of achieving post-PCI TIMI flow grade 3 (OR: 1.52, 95% CI: 1.06-2.20). It was also associated with a reduction in all-cause mortality (OR: 0.59, 95% CI: 0.36-0.98). No significant difference was observed in greater than or equal to 50% ST-segment resolution (OR: 1.04, 95% CI: 0.71-1.50). High-dose statin loading before primary PCI in STEMI patients seems to be associated with improved coronary reperfusion and reduced all-cause mortality. These findings offer timely and clinically relevant insight, reminding the cardiovascular community of the potential value of this therapeutic.

The Synergy between Percutaneous Coronary Intervention with Taxus (SYNTAX) Score quantifies the complexity of coronary artery disease. The Controlling Nutritional Status (CONUT) score is a nutritional index linked to cardiovascular outcomes. This study investigates the correlation between SYNTAX Score and CONUT scores in stable angina pectoris (SAP). This single-center, retrospective study included 259 patients with a first-time diagnosis of SAP who underwent coronary angiography. Patients were divided into low SYNTAX Score (≤22, n = 192) and high SYNTAX Score (>22, n = 67) groups. The CONUT score, derived from serum albumin, total lymphocyte count, and total cholesterol, was calculated for all patients. The median CONUT score was significantly higher in the high SYNTAX Score group (3 vs. 1; P < 0.001). Impaired nutritional status (CONUT ≥ 2) was more prevalent in the high SYNTAX Score group (71.6 vs. 37.5%; P < 0.001). A significant positive correlation was found between SYNTAX Score and CONUT score (P < 0.001). A CONUT score more than 1.5 predicted high SYNTAX Score with 71.6% sensitivity and 62.5% specificity [area under the curve = 0.746, 95% confidence interval (CI): 0.672-0.820, P < 0.001]. In multivariable analysis, diabetes mellitus [odds ratio (OR): 2.47, 95% CI: 1.27-4.83, P = 0.008] and CONUT score (OR: 1.60, 95% CI: 1.32-1.95, P < 0.001) were independent predictors of high SS. A significant positive correlation exists between SYNTAX Score and CONUT score in SAP patients, indicating that worse nutritional status is associated with more complex disease. Nutritional assessment should be integrated into risk evaluation.

To assess whether non-ECG-gated computed tomography (CT) reliably quantifies aortic valve calcification (AVC) for diagnosing severe aortic stenosis and to compare the agreement and diagnostic performance of Agatston versus volume scoring. In this retrospective single-centre study, 129 consecutive patients with echocardiographically confirmed severe aortic stenosis (mean age, 83.1 ± 6.3 years; 46 men, 83 women) underwent same-session ECG-gated (3 mm) and Non-ECG-gated (5 mm) non-contrast CT between 21 March 2020 and 16 April 2025. AVC was quantified using Agatston and volume methods. Agreement between non-gated and gated scores was assessed by Pearson correlation, Bland-Altman analysis, and Deming regression. Diagnostic performance for sex-specific Agatston thresholds (≥2000 units men, ≥1300 units women) was evaluated using receiver operating characteristic (ROC) analysis. Volume scores on non-ECG-gated CT correlated more strongly with ECG-gated CT scores than Agatston scores (r = 0.95 vs. 0.69, P < 0.001). Bland-Altman analysis demonstrated substantial negative bias and proportional error for Agatston scores (mean difference, -921.1 units; limits of agreement, -2900.8 to +1058.6), while volume scores showed minimal bias and no proportional error (+16.5 mm3; -648.5 to +681.4). Deming regression confirmed closer agreement for volume scores (slope, 1.02; R2 = 0.90). ROC analysis showed higher area under the curve values for volume scores (0.976 for men, 0.975 for women) than for Agatston scores (0.946 and 0.967, respectively). Non-ECG-gated CT enables reliable quantification of aortic valve calcium in severe aortic stenosis. Volume scoring demonstrates superior agreement and diagnostic performance compared with Agatston scoring, supporting its use as a robust, density-independent metric for opportunistic assessment of AVC on routine chest CT.

Renin-angiotensin system inhibitors (RASi), including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, improve outcomes after acute myocardial infarction. However, in the drug-eluting stent (DES) era with routine percutaneous coronary intervention (PCI), the duration and timing of benefit after ST-elevation myocardial infarction (STEMI) remain uncertain. Using the nationwide prospective Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry, we identified STEMI patients who underwent successful DES-PCI and survived to discharge (n = 5017). RASi exposure was defined at discharge for analyses from 0 to 12 months and reassigned at a 12-month landmark for analyses from 12 to 36 months, reflecting real-world switching or discontinuation. The primary outcome was all-cause mortality. Confounding was addressed using 1 : 1 propensity-score matching (851 pairs) and Cox proportional hazards models. At discharge, 4093 patients received RASi and 924 did not. At 12 months, all-cause mortality was lower with RASi in the overall cohort [2.1 vs. 4.5%, hazard ratio: 0.45, 95% confidence interval (CI): 0.31-0.66, P < 0.001] and matched cohort (3.0 vs. 4.9%, hazard ratio: 0.61, 95% CI: 0.37-1.00, P = 0.050), driven by fewer cardiac deaths. Over 36 months, RASi was associated with lower mortality overall and after matching. From 12 to 36 months, landmark analyses showed neutral associations. First-year left ventricular ejection fraction and blood pressure improved more with RASi (both P < 0.01). In STEMI treated with DES-PCI, RASi at discharge offers a survival benefit concentrated within the first year. After 12 months, associations were neutral among event-free survivors, supporting early initiation and maintenance of RAS inhibition with individualized reassessment beyond 1 year.