Background Septal arteries (SAs) are often considered minor branches, yet certain anatomies—particularly when a large septal artery (SA) provides collateral perfusion to a chronically occluded coronary vessel—carry substantial electromechanical risk. Abrupt loss of such a large SA during percutaneous coronary intervention (PCI) may compromise both conduction system perfusion and myocardial territories in selected anatomical settings. Although SA occlusion is typically benign, delayed complete atrioventricular (AV) block and severe left ventricular dysfunction are rarely reported complications. Case A 62-year-old man presented with typical chest pain and was diagnosed with non–ST-elevation myocardial infarction. The baseline electrocardiogram showed normal sinus rhythm without conduction abnormalities. Coronary angiography revealed culprit proximal-mid left anterior descending artery (LAD) lesions and a chronic total occlusion of the right coronary artery, supplied by a large collateral-providing first SA. During intravascular ultrasound-guided PCI of the LAD, this major SA became unintentionally occluded despite protection with a jailed wire. Immediately afterward, serial electrocardiograms demonstrated a new bifascicular block pattern—complete right bundle branch block with right axis deviation—which persisted over the next two days. At 62 hours post-PCI, the patient developed late-onset complete AV block. Echocardiography showed a marked decline in left ventricular ejection fraction (LVEF) from 61% to 32%, consistent with new septal akinesia and inferior/inferolateral wall-motion abnormalities, suggesting a clinically significant ischemic insult following SA occlusion. Given the persistence of complete AV block requiring pacing support and the severely reduced LVEF, early cardiac resynchronization therapy with defibrillator (CRT-D) implantation was performed. The patient stabilized thereafter and was discharged in good condition. Conclusion This case highlights that occlusion of a collateral-supplying major SA may result not only in conduction disturbances but also in significant left ventricular systolic dysfunction, producing an uncommon combined electromechanical presentation. Recognition of this high-risk anatomy during PCI planning—including an understanding that even anatomically appropriate protection strategies may not fully prevent septal branch loss—underscores the need for individualized, anatomy-guided side-branch protection, vigilant rhythm monitoring, and timely CRT-D implantation in selected patients.

We retrospectively reviewed 895 patients with Kawasaki disease treated at two Japanese pediatric centers between 2015 and 2024 to assess whether N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels at diagnosis can predict the need for infliximab (IFX) therapy. Patients were divided into (1) the IFX group (n = 35), including patients who received IFX as third-line therapy due to resistance to first- and second-line treatments, including intravenous immunoglobulin, and (2) the non-IFX group (n = 860), including patients who responded to initial therapies. Clinical and laboratory variables were compared between the groups, and predictors of IFX use were analyzed using multivariate logistic regression and receiver operating characteristic (ROC) curves. Multivariate analysis comparing the IFX and non-IFX groups identified older age, lower hemoglobin levels, and higher NT-pro BNP Z-score at diagnosis as independent predictors of later IFX requirement. Additionally, the incidence of coronary arterial lesions did not differ significantly between the groups. ROC analysis demonstrated NT-pro BNP Z-score as a significant predictor (AUC 0.66, p < 0.001), with a cutoff of 2.2 yielding 71.4% sensitivity, 63.3% specificity, 7.3% positive predictive value, and 98.2% negative predictive value. Elevated serum NT-pro BNP Z-score at diagnosis was associated with later IFX use, whereas a low Z-score reliably identified patients unlikely to require IFX. Early assessment incorporating NT-pro BNP may optimize Kawasaki disease therapy and guide the appropriate timing of IFX administration.

Tandem lesions, where extracranial and intracranial vascular pathology coexists, have a poor prognosis and are a significant cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO); they present unique challenges in diagnosis and endovascular treatment. This retrospective study analyzed demographic parameters, risk factors, qualification procedures, fibrinolytic therapy, interventional management, complications, technical aspects, and clinical outcomes in tandem-occlusion anterior circulation stroke (TOS) patients treated at a Thrombectomy Capable Stroke Center (TCSC) in Wejherowo from 2020 to 2024. Acute stroke patients with TOS were compared to two groups: patients with isolated intracranial artery occlusion (iLVO) and patients with isolated extracranial internal carotid artery (iICA) lesion. A total number of 193 patients who underwent endovascular therapy (EVT) were involved. The comparison between selected populations was performed to analyze frequency, risk factors, procedure complexity, complications, and clinical outcome. In the observed group the prevalence of tandem lesions was 17.1%, isolated extracranial internal carotid artery (ICA) occlusion was 11.4%, and isolated intracranial artery occlusion-71.5%. Tandem and ICA occlusion patients were younger (66.21 ± ± 9.8 vs. 70.34 ± 12.16; p < 0.01) and had a higher prevalence of smoking (45% vs. 26.1%; p < 0.05) compared to the intracranial LVO group. The latter had a higher rate of atrial fibrillation (21.2% vs. 60.9%; p < 0.001). Time intervals, including onset-to- -reperfusion (301.66 vs. 246.15 minutes; p < 0.01) and related to it: groin-to-first pass, groin-to-recanalization were significantly prolonged in the tandem group. Clinical outcomes, as measured by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), were worse in the tandem group compared to both the intracranial LVO (mRS 0-2: 24.2% vs. 44.9%; p < 0,01; NIHSS: 9.96 vs. 7.01; p < 0.01) and isolated extracranial ICA occlusion groups (mRS 0-2: 24.2% vs. 59.1%; p < 001; NIHSS: 9.96 vs. 4.53; p < 0.01). There were no significant differences in complication rates between the groups. In the analyzed cohort of interventionally treated AIS patients, the presence of tandem lesions was correlated with poor clinical outcomes and associated with the presence of atherosclerosis risk factors. Endovascular procedures in these cases were more complex and involved extended time intervals. Conversely, patients with isolated intracranial lesions were generally older, with atrial fibrillation being the primary risk factor. In these patients, endovascular procedure times were shorter and resulted in more favorable clinical outcomes.

Introduction: Kawasaki disease, a vasculitis of unknown origin, is currently the main cause of acquired heart disease during childhood and its main sequels are associated with coronary arteries. Therefore, early identification of possible coronary lesions enables adequate treatment to decrease their occurrence.Objectives: The aims of this study were to determine the probability of coronary injury in patients with Kawasaki disease, to identify the risk factors for developing coronary lesions and the long-term outcome of these patients. Methods: A total of 245 children with mean age of 3.48 years were diagnosed with Kawasaki disease between October 1988 and December 2013. Age, sex, clinical and laboratory criteria of Kawasaki disease, echocardiographic findings and long-term outcome were analyzed, and the odds ratio was used to assess their participation as probable risk factors for coronary lesions. Results: Thirty-nine patients presented coronary lesions: 25 male and 14 female patients with mean age of 2.05 years. Risk factors were: age &lt; 3 years; prolonged fever ≥ 6 days, erythrocyte sedimentation rate &gt; 50 mm/hr; C-reactive protein &gt; 100 mg/L and hematocrit &lt; 30%. Thirteen patients showed transient coronary artery dilation, 12 solitary small or medium-sized aneurysms, 7 multiple coronary aneurysms, 6 giant coronary aneurysms and one myocardial infarction by severe obstructive lesion. In-hospital mortality was 4‰. Conclusions: Risk of coronary artery lesions in patients with Kawasaki disease was 15.91%. Risk factors were age under 3 years, fever lasting more than 6 days, erythrocyte sedimentation rate &gt; 50 mm/hr; C-reactive protein &gt; 100 mg/L and hematocrit &lt; 30%. In patients with persistent residual coronary lesions treated conventionally there were no adverse events in the mid- and long-term follow-up.

Coronary angiography (CAG) plays a critical role in the detailed anatomical assessment of coronary artery lesions (CALs) during the early recovery phase of Kawasaki disease (KD) in children. However, its practical experience and reported outcomes in pediatric populations remain limited. To summarize the coronary angiographic features and evaluate the safety and feasibility of CAG in children with KD complicated by CALs. We retrospectively analyzed the clinical and angiographic data of 15 consecutive children with KD complicated by CAL (KD-CAL) who underwent CAG during the recovery phase (3-6 months after disease onset) at our center between June 2020 and June 2024. Preoperative transthoracic echocardiography was performed for CAL assessment, followed by selective CAG under general anesthesia. Procedural parameters, lesion characteristics, and clinical outcomes were systematically reviewed. All 15 children (median age 1.5 years) successfully completed CAG without immediate complications. A total of 21 CALs were identified, predominantly located in the left main stem (38.1%, 8/21) and the proximal left anterior descending branch (38.1%, 8/21). Lesion distribution included small aneurysms/dilatations (47.4%), medium aneurysms (31.6%), and giant aneurysms (21.0%). CAG detected one case of coronary stenosis with collateral vessel formation and one case of intra-aneurysmal thrombosis, both missed by preoperative echocardiography. No significant differences were observed in aneurysm dimensions (inlet, widest, outlet diameters, and length) or in Z-scores between echocardiography and CAG (all P > 0.05). Median fluoroscopy time was 3.1min, radiation dose-area product was 42Gy·cm², and contrast volume was 1.5 mL/kg. During a median follow-up of 33 months, no coronary events occurred. In children with high-risk KD-CAL, invasive coronary angiography (CAG) is a safe and feasible procedure that provides superior anatomical detail for detecting critical complications such as stenosis and thrombosis. Echo-cardiography remains the first-line modality for aneurysm sizing and serial monitoring. However, for comprehensive coronary assessment following echocardiography, CT coronary angiography (CTCA) is the preferred non-invasive imaging standard. Invasive CAG should be reserved for selected high-risk or complex cases where it provides decisive anatomical and functional information to guide definitive management.

Nephrosclerosis-Related Histopathological Findings by Cortical Region From a Japanese Community-Based Study.

ObjectiveThe study was performed to examine clinical outcomes of bypass surgery for recurrent superficial femoral artery (SFA) occlusive lesions after endovascular treatment (EVT).MethodPatients who underwent bypass surgery for a recurrent SFA lesion after EVT at 4 Japanese vascular centers from 2015 to 2020 were analyzed retrospectively. The primary endpoint was graft patency (primary, assisted primary, and secondary).ResultsA total of 46 patients were included in the study. The patients had high rates of hypertension (85%), diabetes (70%), and chronic kidney disease (63%). Clinical presentation before EVT was intermittent claudication in 16 cases (35%) and chronic limb-threatening ischemia in 30 cases (65%). Initial EVT was performed for complex SFA lesions (lesion length, 200 [125-260] mm; reference vessel diameter, 5.3 [4.7-6.0] mm; chronic total occlusion, 50%; poor below-the-knee runoff vessel, 60%). The final device was a bare-nitinol stent in 26 cases (56%), stent graft in 9 (20%), and drug-eluting stent in 7 (15%). A total of 46 surgical reconstructions (above-the-knee femoropopliteal bypass, 15 (33%); below-the-knee femoropopliteal bypass, 7 (15%); tibial bypass, 24 (52%)) were performed using autologous vein grafts (72%) and prosthesis grafts (28%) in a median period of 300 [145-556] days from initial EVT. The median procedure time was 201 [159-299] min. No case had early graft occlusion or hospital death within 30 days. The median follow-up period was 27 (12.7-49.2) months. The 3-year primary, assisted primary, and secondary graft patencies were 57%, 70%, and 77%, respectively; the 3-year limb salvage was 84%; and the 3-year survival was 66%.ConclusionMedium term outcomes were acceptable in patients with bypass surgery for a recurrent SFA lesion after EVT.

The magnitude of the association between fibromuscular dysplasia (FMD) and spontaneous cervical artery dissection (sCeAD) remains uncertain, since data available derive from uncompleted vascular screening. This study aims to assess the frequency and types of cervical and extra-cervical arterial lesions, particularly of the FMD type, in patients with sCeAD. We recruited all patients with a diagnosis of sCeAD from January 2016 to December 2023. All patients underwent full-body vascular imaging to assess the presence of cervical and extra-cervical multifocal and focal stenosis, aneurysms, dissections, tortuosity, ectasia/dilatation or parietal irregularities. Of the 94 patients included (65.7% male; 48.8 ± 8.7 years old), 31.9% had evidence of cerebrovascular FMD. After a whole-body vascular screening, all-type of extra-cervical vascular abnormalities were identified in 47.5% of patients. Twenty-one percent of patients (21.3%) had evidence of extra-cervical FMD, affecting renal (11.5%), visceral (13.1%), and limb (6.7%) arteries. Prevalence of extra-cervical dissections and aneurysms was 14.8% and 9.8%, respectively. After a whole-body screening, overall prevalence of FMD raised from 32.8% to 39.3%. Patients with FMD were mainly female ( P < 0.0001), had a history of migraine ( P = 0.023) and recurrent sCeADs ( P = 0.025). After a multivariate analysis, female sex ( P < 0.0001) and, almost, a positive history of recurrent sCeADs ( P = 0.053) were identified as predictors of FMD in patients with sCeADs. The study reveals a high prevalence of FMD and other vascular abnormalities outside the cervical arteries in patients with sCeAD, highlighting the importance of a comprehensive vascular screening, especially in women and in patients with a positive history of recurrent sCeAD.

United States Veterans who served in Vietnam, the Korean Demilitarized Zone, or Thailand Air Force bases from 1962 to 1971 were likely exposed to Agent Orange, as approximately 107 million pounds of the chemical were sprayed in the areas where the fighting occurred. Agent Orange was an herbicide used by the United States military to kill the jungle, foliage, tall grasses, bushes, and weeds. Agent Orange contained 2,3,7,8-tetrachlorodibenzo-p-dioxin, the most toxic form of dioxin, which has been associated with multiple disease processes and cardiac issues. An original quantitative descriptive, retrospective cohort, secondary data analysis study was conducted utilizing data collected by the Veterans Health Administration (VHA) via the Cardiovascular Assessment, Reporting, and Tracking System for Cath Labs and the Computerized Patient Record System. A new and innovative Structured Query Language report was created for data mining. Statistical tests included Chi-square tests, two-sample t-tests, prevalence, logistic regression, and odds ratios. A secondary analysis was conducted to assess for confounders, associations, and differences. Veterans exposed to Agent Orange status post (s/p) percutaneous coronary intervention (PCI) have significantly higher body mass index (P ≤ .01), with a higher percentage of obesity (45.4% vs. 41.0%) and severe obesity (7.0% vs. 6.1%). There is a higher prevalence of those exposed to Agent Orange in the white (85% vs. 79.3%, P ≤ .01) and non-Hispanic/Latino (93.9% vs. 92.9%, P ≤ .01) male population. There is a higher prevalence of hypertension (91.3% vs. 90.7%, P = .03), hyperlipidemia (91.7% vs. 90.1%, P ≤ .01), and diabetes (53.5% vs. 49.8%, P ≤ .01) in those exposed vs. non-exposed. Lastly, there is a higher prevalence (1.8% vs. 1.5%) and fully adjusted odds 1.22 (95%CI: 1.08, 1.37; P = .0011) of coronary artery bypass graft surgery (CABG). Veterans exposed to Agent Orange are high-risk cardiovascular patients with a higher prevalence and odds of CABG s/p PCI. The increased prevalence of hypertension, hyperlipidemia, obesity, severe obesity, and diabetes in Veterans exposed to Agent Orange s/p PCI suggests that Agent Orange may contribute to the development of these disease processes. Strengths include the quality and longevity of the data collected, the Promise to Address Comprehensive Toxics (PACT) Act supporting Agent Orange research, and the advanced age of the Veterans increases the likelihood of cardiovascular disease. Weaknesses include the inability to quantify and confirm Agent Orange exposure, the inability to determine causation, and the VHA registrar's office could have erroneously assigned the Agent Orange disability flag by not verifying the service location. This study impacts the care of the Veterans s/p PCI; providers should assess the comorbidities, coronary artery disease progression, number of vessels affected, tortuosity of the cardiac vessels, location of the coronary artery lesion(s), size of the lesion(s), and the number of stents needed to determine if repeat PCI is the preferred treatment over CABG. Future studies should include the newly categorized Veterans exposed to Agent Orange from the PACT Act screenings, the CABG outcomes, the characteristics of the coronary lesions, the type of stent(s), and the medications prescribed at the time of the original PCI.

Clinical outcomes and optical coherence tomography findings in myocardial infarction patients without standard modifiable risk factors: Insights from the TACTICS registry.

Despite the successes of preventive cardiology associated with effective impact on modifiable risk factors of heart diseases, the main cause of death worldwide remains coronary heart disease. The development of atherosclerosis is based on the violation of lipid metabolism and local inflammation of the vascular wall. Hematological indexes may be new marker in predicting the severity of atherosclerotic lesion of the coronary arteries. Purpose. To compare the hematological indices in patients with atherosclerosis of the coronary arteries of varying severity. Material and methods. The study included 88 patients who were divided into three groups: without coronary artery atherosclerosis (n = 31), with non-stenotic coronary artery atherosclerosis (n = 26), and with stenotic coronary artery atherosclerosis (n = 31). The average age of the patients was 58.5±7.9 years. The following hematological parameters were determined: NLR (neutrophil-lymphocyte ratio), PLR (platelet-lymphocyte ratio), MLR (monocyte-lymphocyte ratio), SII (systemic inflammation index). SIRI (Index of systemic inflammatory response). The data obtained was processed using the statistical packages Excel, Statistica 10.0. Results. The SIRI hematological index was significantly higher in the group of patients with coronary artery stenosis compared with patients with non-stenosing coronary artery atherosclerosis (1.20 (0.96; 1.74) and 0.85 (0.66; 1.21), respectively, p &lt; 0.007) and patients without coronary artery atherosclerosis (1.20 (0.96; 1.74) and 0.77 (0.54; 1.21), respectively, p &lt; 0.002). The NLR was also higher in the group of patients with stenotic coronary artery atherosclerosis compared to patients without coronary artery atherosclerosis (2.03 (1.67; 2.74) and 1.54 (1.33; 2.03), respectively, p &lt; 0.007). Conclusion. Hematological indexes, along with traditional risk factors, can become promising and economically accessible biomarkers in routine practice, used in the prediction of the severity of coronary atherosclerosis and the stratification of cardiovascular risk. The introduction of the use of hematological indexes as additional criteria of prognostic models is of scientific and practical interest and requires further study.

Intravascular Lithotripsy or Mechanical Debulking in Complex Calcified Coronary Arteries: Multicenter, Prospective ROLLING STONE Study.

Analysis of risk factors of coronary artery lesions in Kawasaki disease and study of IVIG treatment response.

The anatomical and pathophysiological characteristics of coronary artery disease vary between the sexes. This study investigated the impact of sex on outcomes in patients with de novo coronary artery lesions treated with drug-coated balloons (DCB) or drug-eluting stents (DES). REC-CAGEFREE I was an investigator-initiated, non-inferiority trial conducted at 43 sites in China from Feb 5, 2021, to May 1, 2022, which randomized 2,272 patients for treating de novo coronary lesions, regardless of vessel diameter. After successful lesion pre-dilatation, eligible patients were randomized (1:1) to either DCB angioplasty with the option of rescue stenting or intended DES deployment. In this prespecified subgroup analysis, patients were analyzed by sex based on their medical records. The primary endpoint was device-oriented composite endpoint (DoCE), including cardiovascular death, target-vessel myocardial infarction, and clinically and physiologically indicated target lesion revascularization at 2years. Between-group differences were compared by Cox proportional-hazards models, and imbalances in baseline characteristics were adjusted with inverse probability of treatment weighting (IPTW). The analyses were conducted in the intention-to-treat population. A total of 2,272 participants underwent randomization, of which 698 (30.7%) were female and 1,574 (69.3%) were male. At 2 years, no statistically significant differences in the incidence of DoCE were observed between sexes (36 [5.2%] for females and 74 [4.7%] for males, HRIPTW:1.04, 95%CI:0.67 to 1.61, P = 0.877). Compared with DES, DCB was associated with a numerically higher risk of DoCE in females (6.3% versus 3.9%, HRIPTW:1.55, 95%CI:0.78 to 3.11, P = 0.210) and a statistically significant higher risk in males (6.4% versus 3.1%, HRIPTW:2.28, 95%CI:1.40 to 3.70, P = 0.001), respectively, with no significant sex-by-treatment (DCB/DES) interaction observed (Pinteraction = 0.575). The prognosis of DCB and DES differed significantly between small vessel disease (SVD) and non-SVD among females (Pinteraction = 0.007), but not among males (Pinteraction = 0.408). For patients with de novo, non-complex coronary artery disease, DCB was associated with a significantly higher risk of 2-year DoCE compared with DES in males, whereas a consistent but non-significant trend was observed in females. ClinicalTrials.gov identifier: NCT04561739.

Automated assessment of coronary artery (CA) lesions via Coronary Computed Tomography Angiography (CCTA) is essential for the diagnosis of coronary artery disease (CAD). However, current deep learning approaches confront several challenges, primarily regarding the modeling of long-range anatomical dependencies, the effective decoupling of plaque texture from stenosis geometry, and the utilization of clinically prevalent mixed-grained annotations. To address these challenges, we propose a novel mixed-grained hierarchical geometric-semantic learning network (MG-HGLNet). Specifically, we introduce a topology-aware dual-stream encoding (TDE) module, which incorporates a bidirectional vessel Mamba (BiV-Mamba) encoder to capture global hemodynamic contexts and rectify spatial distortions inherent in curved planar reformation (CPR). Furthermore, a synergistic spectral-morphological decoupling (SSD) module is designed to disentangle task-specific features; it utilizes frequency-domain analysis to extract plaque spectral fingerprints while employing a texture-guided deformable attention mechanism to refine luminal boundary. To mitigate the scarcity of fine-grained labels, we implement a mixed-grained supervision optimization (MSO) strategy, utilizing anatomy-aware dynamic prototypes and logical consistency constraints to effectively leverage coarse branch-level labels. Extensive experiments on an in-house dataset demonstrate that MG-HGLNet achieves a stenosis grading accuracy of 92.4% and a plaque classification accuracy of 91.5%. The results suggest that our framework not only outperforms state-of-the-art methods but also maintains robust performance under weakly supervised settings, offering a promising solution for label-efficient CAD diagnosis.

Background and objectivesPeople living with HIV (PLWH) are increasingly at risk for cardiovascular disease (CVD) due to chronic inflammation, metabolic dysregulation, and long-term antiretroviral therapy (ART). However, limited data exist regarding coronary anatomy and long-term outcomes in PLWH with acute coronary syndrome (ACS), particularly in Chinese populations. This study aimed to compare coronary angiographic characteristics, metabolic-inflammatory profiles, and 2-year prognosis between PLWH and HIV-uninfected patients with ACS.MethodsWe conducted a single-center observational cohort study including 129 patients with a first episode of ACS between 2019 and 2023. 43 PLWH were analyzed with 86 HIV-uninfected controls. Coronary artery lesions were assessed by angiography and SYNTAX score. Laboratory parameters including CRP and lipid levels, among others, were collected. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events during the 2-year follow-up period.ResultsPLWH had significantly higher SYNTAX scores compared to HIV-free patients (21.56 vs. 16.77, P = 0.001). They also showed elevated levels of LDL-C (3.18 vs. 2.66 mmol/L, P = 0.009) and CRP (median 9.10 vs. 5.10 mg/L, P < 0.001). At 2 years, PLWH had a higher rate of ACS recurrence (18.6% vs. 7.0%, P = 0.089), but mortality and other adverse events were similar. In multivariate analyses, HIV status was not an independent predictor of relapse, while calcified lesions were significantly associated with relapse.ConclusionPLWH with ACS have more complex coronary heart disease and a higher risk of recurrence, partly due to vascular calcific changes. These findings suggest the need for enhanced metabolic monitoring and individualized secondary prevention strategies in this high-risk population.

BackgroundThe complexity of coronary artery lesions and glucose metabolic disorders contributes to adverse long-term prognosis following percutaneous coronary intervention (PCI). This study aimed to evaluate the synergistic effect of coronary artery lesions—assessed by the SYNTAX score—and glucose metabolic disorders—quantified by the hemoglobin glycation index (HGI)—on predicting major adverse cardiac and cerebrovascular events (MACCEs) after PCI.MethodsA total of 609 coronary artery disease (CAD) patients undergoing PCI were enrolled in the final analysis. HGI was calculated by subtracting the predicted HbA1c (derived from fasting plasma glucose regression) from the observed HbA1c. Pearson’s coefficients were used for correlation analyses. Kaplan–Meier and Cox regression analyses were used to assess associations with MACCEs. Mediation analysis evaluated whether the SYNTAX score mediated the HGI–MACCEs relationship.ResultsPatients with higher HGI and SYNTAX scores (≥1.16764 and >22, respectively) exhibited a significantly increased mortality risk (p = 0.0052) and more complex coronary lesions. Multivariable analysis confirmed HGI and SYNTAX score as independent predictors of MACCEs. Additionally, the SYNTAX score partially mediated the association between HGI and adverse outcomes, with a mediation proportion of 13.05%.ConclusionThe HGI and SYNTAX score exert a synergistic effect in predicting the severity of CAD and the risk of adverse prognosis after PCI. It highlights the necessity of integrating both metabolic and anatomical assessment indices for comprehensive risk stratification of CAD patients undergoing PCI.

IVUS, OCT, or Angiography as Guidance for PCI in Complex Coronary Artery Lesions: Network Meta-Analysis of Randomized Controlled Trials.

Consensus-Driven Vessel Preparation and Definitive Endovascular Treatment Strategies for Femoropopliteal Arterial Lesions Based on Plaque Morphology.

BackgroundAtherosclerosis counts for 50% of cardiovascular deaths. Recent studies have demonstrated that certain atheromatous plaques with a lipid core and positive remodeling, known as vulnerable plaques, are more likely to develop plaque disruption, resulting in a coronary event. The early identification of these atheromatous plaques would have an extremely important clinical impact and might help to prevent the further development of an acute coronary syndrome. Objective To assess the diagnostic accuracy of coronary angiography with 16-row multidetector computed tomography (16-MCT) for the detection, characterization and quantification of atherosclerotic coronary artery lesions compared to intravascular ultrasound (IVUS). Material and MethodsForty five patients eligible to coronary angiography underwent 16-MCT and IVUS. Plaque burden and the characteristics of atheromatous plaques were analyzed in each coronary segment; plaques were classified in soft, fibrous and calcified. The binomial exact method was used to calculate the diagnostic accuracy of 16-MCT to determine the plaque burden and to identify coronary plaques. ROC curves analysis determined the cut-point for each type of plaque, as well as the mean density and the standard deviation expressed in Hounsfield units (HU). The diagnostic accuracy of the method for the diagnosis of coronary stenosis =50% was also assessed. ResultsThe sensitivity and specificity of 16-MCT to detect plaque burden were 96.20% and 81.96%, respectively. For the detection of soft, fibrous and calcified plaques, the sensitivity and the specificity were 94.59% and 92.62%, 94.91% and 98.56%, and 93.22% and 95.13%, respectively. Using a cut-point of 85 HU, 16-MCT correctly identified 86% of soft and fibrous plaques, with an area under the ROC curve of 0.96; a cut-point of 196.68 UH resulted in an identification of 93% of calcified and non-calcified plaques, and the area under the ROC curve was 0.98. The sensitivity and specificity of the test for detecting coronary stenosis were 81.58% and 93.86%, respectively. Conclusion16-MCT is a promising non-invasive diagnostic tool for the assessment of patients with coronary artery disease, useful for the detection and characterization of the different types of plaques.