Adverse Cardiac Events Research Articles

Long-Term Outcomes in Patients With Chronic Total Occlusion and Left Ventricular Systolic Dysfunction - A Single-Center Inverse Probability of Treatment Weighting Analysis.

The optimal treatment strategy for patients with coronary chronic total occlusion (CTO) and left ventricular systolic dysfunction (LVSD) remains unclear. This study investigated the long-term outcomes of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy (MT) in this specific patient cohort. This retrospective cohort study included 987 consecutive patients with CTO and LVSD who met the inclusion criteria and underwent either CTO-PCI (n=277), CTO-CABG (n=222), or CTO-MT (n=488) between 2014 and 2020. The primary outcome was all-cause mortality during follow-up. Secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and their components, including cardiovascular mortality, myocardial infarction (MI), stroke, unplanned revascularization, and hospitalization for heart failure. During a median follow-up of 5.3 years, 232 (23.51%) patients died from any cause. In the unadjusted analysis, CTO-MT was associated with worse long-term survival prospects. After inverse probability of treatment weighting and variable adjustment, CTO-PCI and CTO-CABG demonstrated significant reductions in the long-term risks of all-cause and cardiovascular mortality. Notably, CTO-CABG was associated with the lowest long-term risks of MACCE, MI, unplanned revascularization, and hospitalization for heart failure. For patients with CTO and LVSD, successful CTO revascularization significantly improved long-term survival compared with CTO-MT. CTO-CABG can be regarded as the optimal treatment modality for better long-term prognosis.

Long-term clinical and angiographic outcome of T-and protrusion technique with ultrathin strut drug eluting stents.

Data about coronary bifurcations treated with ultrathin strut drug-eluting stents (DES) using T-and-protrusion (TAP) technique is limited. In this study, a total of 84 consecutive patients, who underwent bifurcation percutaneous coronary intervention (PCI) with TAP technique using Orsiro® DES (Biotronik, Berlin, Germany), were included. All pre- and post-procedural data, as well as 1- and 2-year follow-up angiograms, were analyzed. Primary endpoints were procedural success and target lesion failure (TLF); secondary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) during follow-up. Procedural success was achieved in 100% of cases. TLF rate was higher in patients presented with acute coronary syndrome compared to the ones with chronic coronary syndrome (19% vs. 5% p = 0.09). All-cause mortality was 30% during follow-up, from which 26% was due to non-cardiovascular cause, and the MACCE rate was 46%. Coronary bifurcations treated with ultrathin strut DES showed good short-term results and were associated with acceptable cardiovascular mortality. However, in these long-term patients, the rate of MACCE and non-cardiovascular death were rather high.

Role of Multimodality Imaging in Cardiac Sarcoidosis: A Retrospective Single-Center Experience

Background/Objectives: Cardiac sarcoidosis (CS) is a rare entity characterized by granulomatous infiltration of the myocardium, which can lead to myocardial fibrosis, conduction abnormalities, and the development of heart failure, thereby elevating the risk of sudden cardiac death (SCD). While endomyocardial biopsy (EMBx) is regarded as the gold standard for diagnosis, its low sensitivity and inherent procedural risks may limit its practical application. Methods: This study retrospectively explored the role of advanced imaging modalities, specifically cardiovascular magnetic resonance imaging (CMR) and fluorodeoxyglucose positron emission tomography (FDG-PET), in the diagnosis and management of CS within a single center. In this retrospective study, we aimed to assess the utility of advanced imaging modalities in the clinical diagnosis of CS and the monitoring of treatment. Results: A total of 92 patients were identified as having cardiac sarcoidosis, with males constituting 66.3% of the sample and a mean age of 62 years (±11.9). Among these patients, 80 (87%) underwent FDG-PET. Here, the basal inferolateral segment was the most frequently observed segment of the heart with FDG uptake. A total of 77 patients (84%) underwent CMR, with 51 demonstrating late gadolinium enhancement (LGE). The basal inferolateral segment exhibited the highest frequency of LGE (26%). Logistic regression analysis indicated that patients presenting with a combination of LGE, FDG uptake on PET, and a “mismatch pattern” faced a two-fold increase in the risk of experiencing major adverse cardiac events (odds ratio = 2.311, p = 0.077). Conclusions: This study underscores the importance of multimodality imaging as a non-invasive alternative for CS diagnosis and management, reducing reliance on EMBx.

Effect of PCSK9 inhibitors on major cardiac adverse events and lipoprotein-a in patients with coronary heart disease: a meta-analysis.

Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease due to its unique apo(a) component and its association with atherosclerosis and thrombogenesis. This meta-analysis was conducted to evaluate the effects of PCSK9 inhibitors on major adverse cardiac events (MACE) and Lp(a) levels in patients with coronary heart disease. Randomized controlled trials (RCTs) were systematically searched in PubMed, the Cochrane Library, and other databases. Stata 15.1 software was used for data analysis, and a random- or fixed-effects model was selected based on inter-study heterogeneity. Egger's test was applied to detect publication bias. A total of 12 RCTs were included, involving 48 116 patients with a mean age of 62 years, comprising 65% males and diverse ethnic backgrounds. The results showed that compared with the control group, PCSK9 inhibitors significantly reduced low-density lipoprotein cholesterol (WMD = -1.24 mmol/L, 95% confidence interval (CI): -1.28 to -1.20), total cholesterol, triglycerides, and Lp(a) levels while increasing high-density lipoprotein cholesterol levels. In terms of safety, there was no increased risk of adverse reactions other than injection site reactions. For MACE, PCSK9 inhibitors significantly reduced the risk of nonfatal myocardial infarction, stroke, and coronary revascularization events (RR = 0.87, 95% CI: 0.84-0.89). PCSK9 inhibitors not only significantly improve blood lipid profiles and reduce Lp(a) levels but also reduce the risk of MACE in patients with coronary heart disease. Therefore, PCSK9 inhibitors offer an effective and safe treatment option for these patients.

Rota-Tripsy or step-up-approach rotational atherectomy for severe coronary artery calcification treatment: a comparative effectiveness study

Step-up-approach rotational atherectomy has been widely recognized in the treatment of severe calcified plaques. As an alternative, the rota-tripsy procedure is a novel strategy for the modification of calcification lesions. This study aimed to evaluate and compare the efficacy and safety of rota-tripsy and step-up-approach rotational atherectomy, given the limited clinical data available. Clinical data of 3652 patients with coronary calcification were retrospectively collected from February 2021 to February 2024. The cases were divided into two groups based on the technical approach. The primary efficacy endpoint was procedural success (stent expansion rate > 70% and no hospital major adverse cardiac events [MACEs]). The primary safety endpoint was the absence of serious angiographic complications and 30 days MACEs. A total of 37 patients (38 calcified lesions) screened and included in the study, with 18 cases (19 lesions) in group A and 19 cases in group B. The results showed no significant differences in primary efficacy endpoint. However, group A recorded a lower incidence of angiographic complications (P = 0.02) and shorter dose area product and fluoroscopy/interval times compared with group B (P < 0.01). For management of severe coronary calcification, both rota-tripsy and step-up-approach rotational atherectomy had favorable short-term clinical results; however, rota-tripsy provided improved safety and efficiency.

Thrombus aspiration in primary percutaneous coronary intervention in acute ST-elevation myocardial infarction patients with high thrombus burden: one-year outcomes in a tertiary healthcare center in Ho Chi Minh City

Abstract Background Primary percutaneous coronary intervention (PCI) can dislodge atherosclerotic debris, risking microvascular embolism. Thrombus aspiration (TA) before stenting in ST-segment elevation myocardial infarction (STEMI) patients has been linked to reduced mortality, lower recurrence of heart attacks, and improved cardiac function. However, limited research exists on the effectiveness of TA in Vietnam, underscoring the need for further studies to enhance cardiovascular care. This prospective observational study was conducted to evaluate the role of TA in STEMI patients admitted with a substantial thrombus burden at Nguyen Tri Phuong Hospital. Results Out of 92 participants, 68 underwent TA treatment. Post-treatment, the TA group exhibited better TIMI and TMP flow grades and a higher rate of ST-segment normalization, with no significant difference in major adverse cardiac events (MACEs) at 30-day and 12-month follow-ups compared to those untreated. Conclusions TA during PCI enhances ST-segment normalization and TIMI and TMP scores in STEMI patients, improving myocardial perfusion. No difference in MACE occurrence was noted between groups after 30 days and 12 months, suggesting TA’s potential benefits without increasing adverse outcomes.

Comparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19.

Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19. A multicenter retrospective cohort study was conducted from January 2021 to December 2021. All of the consecutive patients with severe COVID-19 receiving 6 mg/day dexamethasone were eligible for inclusion. The primary outcome was the incidence of in-hospital mortality for patients treated with dexamethasone 6 mg/day for the standard duration of 10 days versus an extended duration of >10 days. A total of 1294 patients met the inclusion criteria: 803 received the standard duration of dexamethasone and 491 received the extended duration. The incidence of in-hospital mortality was significantly higher (P = 0.003) in the extended duration group (36.5%) compared with the standard duration group (28.5%), with no significant difference in in-hospital major adverse cardiac events (16.1% for extended vs 13.2% for the standard duration; P = 0.15). The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.

Cardiac MRI Pectoralis Muscle Thickness as a Measure of Sarcopenia: Prognostic Significance, Interreader Agreement, and Physiologic Correlation.

Purpose To evaluate pectoralis muscle thickness at routine cardiac MRI as a marker of sarcopenia, including prognostic significance for major adverse cardiac events (MACE), interobserver agreement, and correlation with physiologic parameters. Materials and Methods This retrospective cohort study included adult patients undergoing cardiac MRI for assessment of suspected cardiomyopathy between October 2018 and February 2020. Measurements of maximum pectoralis major thickness were performed by two experienced radiologists using axial images at the level of the carina. A random subset of 50 patients were re-evaluated to assess intra- and interobserver agreement. The primary end point was MACE, defined as a composite of cardiac death, resuscitated sudden cardiac death, appropriate implantable cardioverter defibrillator discharge, or hospitalization for heart failure. Prognostic significance of pectoralis major thickness measurements for MACE was assessed using Cox proportional hazard models, and correlation between muscle thickness measurements and cardiopulmonary exercise testing (CPET), performed within 1 year of MRI, was assessed using Spearman correlation. Results The study included 1045 patients (mean age, 50 years ± 17 [SD]; 642 male, 403 female). After median follow-up of 3.3 years (IQR: 2.3-3.9 years), MACE occurred in 66 patients. In multivariable models adjusted for patient age, left ventricular ejection fraction, late gadolinium enhancement, and cardiomyopathy cause, pectoralis major muscle thickness was predictive of MACE in both male (hazard ratio [HR], 0.89 [95% CI: 0.85, 0.94]; P < .001) and female patients (HR, 0.85 [95% CI: 0.76, 0.96]; P = .008), with improved model fit in nested models. Pectoralis muscle thickness measurements had excellent intra- and interobserver agreement (intraclass correlation coefficient, 0.99 and 0.95, respectively) and correlated with absolute peak oxygen uptake (r = 0.65, P < .0001) and oxygen uptake efficiency slope (r = 0.61, P < .001) in the subset who underwent CPET within 1 year of MRI (n = 258). Conclusion Pectoralis major muscle thickness at routine cardiac MRI is a simple, reproducible measure of sarcopenia that was associated with MACE occurrence in male and female patients and correlated with CPET parameters. Keywords: Cardiac, Cardiomyopathies, MR Imaging Supplemental material is available for this article. © RSNA, 2024.

Five-year Multiple Comparison of Transcatheter Aortic Valves: Insights from the OBSERVANT II study

BACKGROUNDHead-to-head comparisons of second and third generations of THVs are mostly limited to two-arm studies, and to mid-term follow-up so far. Aim of the study was to simultaneously compare clinical outcomes of transcatheter aortic valve replacement (TAVR) with four different transcatheter heart valves (THVs) at 5 years. METHODSPatients undergoing transfemoral TAVR with four second-generation THV platforms and enrolled in the multicenter, prospective OBSERVANT II study from December 2016 to September 2018, were compared according to the THV received. Outcomes were adjudicated through a linkage with administrative databases and adjusted using inverse propensity of treatment weighting (IPTW) based on propensity score.The primary endpoints were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 5 years. Cumulative rates were reported consecutively for Evolut R/ PRO, SAPIEN 3, ACURATE neo and Portico groups. RESULTSA total of 2,493 patients were considered. The median age was 83 years and the median EuroSCORE 2 was 4.9%. After IPTW adjustment, the rates of all-cause death (53.6% vs. 46.7% vs. 50.5% vs. 46.3%, p=0.06) and MACCE (57.2% vs. 51.2% vs. 54.4% vs. 50.6%, p=0.08) did not differ among groups at 5 years. The rate of re-hospitalization for heart failure (HF) (33.9% vs. 27.0% vs. 31.6% vs. 33.7%, p=0.02) was significantly lower for SAPIEN 3 THV at 5 years. CONCLUSIONSData from real-world practice showed sustained and comparable effectiveness of TAVR considering all the available THVs up to 5 years, but SAPIEN 3 showed a lower rate of rehospitalization for HF.

Coronary Artery Bypass Grafting Plus Mitral Valve Plasty May Not Provide More Advantage in Patients with Coronary Heart Disease and Moderate Ischemic Mitral Regurgitation: An Inverse Probability of Treatment Weighting Retrospective Cohort Study.

To compare the efficacy of isolated off-pump coronary artery bypass grafting (OPCABG) and of coronary artery bypass grafting (CABG) plus mitral valve plasty (MVP) in treating coronary heart disease with moderate ischemic mitral regurgitation to find a better surgical method. Clinical data of 822 patients diagnosed with coronary heart disease and moderate ischemic mitral regurgitation were analyzed retrospectively. Patients were divided into the OPCABG and CABG+MVP groups according to surgical methods. Baseline data of both groups were corrected, and clinical efficacy of the two surgical methods was analyzed and compared using the propensity score inverse probability of treatment weighting (IPTW) method. There were no significant differences in the use of mammary artery grafts, number of grafts, and blood product consumption between the two groups (P>0.05) after IPTW. However, the CABG+MVP group had a significantly longer operation time than the OPCABG group (4.13 ± 0.85 hours vs. 5.65 ± 1.02 hours, P<0.001). No statistically significant differences in postoperative major adverse cardiac and cerebrovascular events were observed between the two groups. However, the intra-aortic balloon pump rate was higher in the CABG+MVP group than in the OPCABG group (12.3% vs. 25.0%, P=0.012). Although CABG+MVP can improve ischemic mitral regurgitation significantly (95.4% vs. 81.2%, P<0.001), there were no significant differences in the cumulative survival rate and the incidence of major adverse cardiac and cerebrovascular events between the groups (P>0.05) after IPTW. CABG+MVP may not provide more advantage in patients with coronary heart disease and moderate ischemic mitral regurgitation.

Exercise stress echocardiography shows impaired left ventricular function after hospitalization with COVID-19 without overt myocarditis: A pilot study.

Usual clinical testing rarely reveals cardiac abnormalities persisting after hospitalization for COVID. Such testing may overlook residual changes causing increased adverse cardiac events post-discharge. To clarify status post-hospitalization, we related exercise stress echocardiography (ESE) in 15 recovering patients (RP) age 30-63 without myocarditis to matching published data from healthy subjects (HS). RP exercise, average duration 8.2 ± 2.2 SD, was halted by dyspnea or fatigue. RP baselines matched HS except for higher heart rate. At peak stress, RP had significantly lower mean left ventricular (LV) ejection fraction (67% ± 7 vs. 73% ± 5, p < 0.0017) and higher peak early mitral inflow velocity/early mitral annular velocity (E/e', 9.1 ± 2.5 vs. 6.6 ± 2.5, p < 0.006) compared with HS performing equal exercise (8.5 ± 2.6 min). Thus, when stressed, patients without known cardiac impairment showed diminished systolic contractile function and diastolic LV compliance vs. HS. RP peak heart rate was significantly higher (172 ± 18 vs. 153 ± 20); peak systolic blood pressure trended higher (192 ± 31 vs. 178 ± 19). Pulmonary artery systolic pressures among RP remained normal. ESE uniquely identified residual abnormality in cardiac contractile function not evident unstressed, exposing previously unrecognized residual influence of COVID-19. This may reflect autonomic dysfunction, microvascular disease, or diffuse interstitial changes; these results may have implications for clinical management and later prognosis.

Type D Personality As a Risk Factor for 3-Year Cardiovascular Events in Patients With Coronary Artery Disease and Their Spouse: A Prospective Cohort Study.

Type D personality has been established as an independent psychological risk factor for adverse outcomes in coronary artery disease (CAD) patients. However, research on the association between Type D personality and cardiovascular events in couples is limited. This study investigated the correlation between Type D personality and cardiovascular outcomes among CAD patients and their spouses. This prospective cohort study included 4,035 CAD patients for first coronary intervention therapy and their spouses, recruited from January 2017 to July 2020. Type D personality, anxiety, depression, and baseline clinical data were assessed for both partners. The major adverse cardiac event (MACE) rate of both CAD patients and their spouses was analyzed after a 3-year follow-up period. A total of 871 CAD patients and 234 spouses developed MACE during the follow-up period. The Cox proportional hazards regression analysis revealed that the Type D(+) patient/Type D(+) spouse group exhibited the highest risk of 3-year MACE in both patients (hazard ratio [HR], 3.834; 95% confidence interval [CI], 2.947-4.987; p < 0.001) and spouses (HR, 2.670; 95% CI, 1.603-4.448; p < 0.001). When analyzing Type D as continuous variables, a synergistic interaction between patient and spouse negative affectivity (NA_patient * NA_spouse) was significantly associated with MACE in both CAD patients (HR, 1.746; 95% CI, 1.517-2.010; p < 0.001) and their spouses (HR, 1.992; 95% CI, 1.843-2.152; p < 0.001). This study suggests that having Type D personality, either in the CAD patient or their spouse, is associated with an increased risk of adverse cardiovascular outcomes in both individuals. Accordingly, the assessment of Type D personality in both partners and the development of tailored, couple-centered interventions are warranted.

Circulating YKL-40 levels but not CHI3L1 or TRIB1 gene variants predict long-term outcomes in patients with angiographically confirmed multivessel coronary artery disease

YKL-40 is significantly associated with the prevalence and severity of coronary artery disease (CAD). YKL-40 levels are significantly associated with variations in the CHI3L1 and TRIB1 genes. We investigated candidate genes for YKL-40 levels and evaluated the prognostic value of this biomarker and corresponding variants for long-term outcomes in patients with CAD. We included 4664 and 521 participants from the Taiwan Biobank (TWB) and CAD cohorts, respectively. Candidate variants for circulating YKL-40 levels were investigated using genome-wide association study (GWAS) data from the TWB cohort, and the results were validated in the CAD cohort. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac events (MACEs), which included the composite endpoints of all-cause mortality, nonfatal acute coronary syndrome, hospitalization for heart failure, and nonfatal stroke. According to the GWAS data from the TWB cohort, three CHI3L1 variants (rs4950928, rs10399931, and rs872129) and one TRIB1 variant (rs6982502) were independently associated with YKL-40 levels. These findings were validated in the CAD cohort. The combined CHI3L1 and TRIB1 weighted genetic risk scores (WGRSs) were not associated with the long-term outcomes (median follow-up period of 3.7 years) in patients with CAD. Conversely, patients with YKL-40 levels in the upper tertile had the highest rates of all-cause mortality and MACEs (log-rank p = 9.58 × 10−8 for all-cause mortality and 1.34 × 10−7 for MACEs). Furthermore, YKL-40 levels predicted poor clinical outcomes only in patients with multivessel CAD (log-rank p = 3.0 × 10−6 for all-cause mortality and 1.10 × 10−5 for MACEs) and not in patients with single-vessel CAD. This study revealed that YKL-40 levels but not the combined CHI3L1 and TRIB1 WGRSs were found to be independent predictors of poor clinical outcomes in patients with multivessel CAD.

Albiglutide and atrial fibrillation in patients with type 2 diabetes and established cardiovascular disease - insights from the Harmony Outcomes trial.

Atrial fibrillation and flutter (AF) are common in patients with type 2 diabetes and are associated with worse outcomes. Harmony Outcomes was a multicenter, event-driven, double-blind, placebo-controlled trial comparing the effects of albiglutide, a glucagon-like peptide-1 (GLP1) receptor agonist, with placebo on a composite of major adverse cardiac events (MACE; non-fatal myocardial infarction; non-fatal stroke and cardiovascular death) in 9,463 patients aged >40years with type-2 diabetes and established cardiovascular disease. Herein, the cardiovascular effects of albiglutide in patients with and without AF, as well as the effects on AF events during follow-up, were analyzed. Patients with a history of AF (8.9%) exhibited a higher event rate for the primary composite MACE endpoint during 1.6 years of follow-up (12.7 vs. 6.3 events/100 person-years, adjusted hazard ratio (aHR)1.41 (95% Confidence Interval (CI)1.14-1.74, p=0.001). Treatment with albiglutide reduced the occurrence of the primary endpoint irrespective of history of AF at baseline (history of AF: aHR0.83 (0.58-1.19), no history of AF: aHR0.77 (0.66-0.90); pinteraction=0.71). During follow-up, 239 patients (2.5%) experienced an AF event. Overall, Albiglutide was associated with numerically fewer AF events (108 vs 131; HR 0.82 (0.63-1.06, p=0.12), irrespective of baseline history of AF (pinteraction=0.92). In patients with type 2 diabetes, treatment with albiglutide, compared to placebo, reduced the risk of cardiovascular events irrespective of history of AF. Further, albiglutide treatment did not increase AF adverse events but was associated with a trend to a lower rate of AF events during follow-up without reaching statistical significance.

Clinical significance of quantitative assessment of right ventricular amyloid burden with [99mTc]Tc-DPD SPECT/CT in transthyretin cardiac amyloidosis.

To evaluate right ventricular (RV) uptake measured by quantitative [99mTc]Tc-DPD SPECT/CT to investigate its role in predicting and evaluating prognosis and therapeutic outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CA). Patients with ATTR-CA were consecutively enrolled for quantitative [99mTc]Tc-DPD SPECT/CT. Ventricular amyloid burden was quantified by SUVmax and TBR. Differences in RV uptake (focal or diffuse) and associations with clinical characteristics and CMR data were evaluated. The primary endpoint was major adverse cardiac events (MACEs), including all-cause deaths, heart failure hospitalizations, complete atrioventricular block, sustained ventricular tachycardia, and atrial fibrillation/flutter. Prognostic associations were evaluated using Cox regression and Kaplan-Meier survival analysis. A secondary endpoint involved a longitudinal SPECT/CT analysis during Tafamidis therapy. The study included 76 patients, all showing both RV and LV uptake on SPECT imaging. Compared with patients with focal RV uptake, patients with diffuse RV uptake had higher serum troponin T levels (P < 0.05), septal thickness (P < 0.01), and external cardiac circulation volume (ECV) (P < 0.05). RV uptake was correlated with septal thickness, ECV, LV uptake, NT-proBNP and troponin-T (all P < 0.05). Among 53 patients, high LV and RV uptake significantly predicted MACEs (P < 0.001), with a median follow-up time of 16 months. A subgroup of 20 patients showed significant reductions in LV and RV uptake after Tafamidis treatment (P < 0.001). Increasing RV amyloid burden quantified by SPECT/CT is associated with advanced disease stage and predicts MACEs, serving as valuable markers for prognosis and treatment monitoring in ATTR-CA.

Abbreviated or Standard Antiplatelet Therapy After PCI in Diabetic Patients at High Bleeding Risk

BackgroundAbbreviated antiplatelet therapy (APT) reduces bleeding without increasing ischemic events in largely unselected high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI). Diabetes mellitus (DM) is associated with higher ischemic risk, and its impact on the safety and effectiveness of abbreviated APT in HBR PCI patients remains unknown. ObjectivesThis study sought to investigate the comparative effectiveness of abbreviated (1 month) vs standard (≥3 months) APT in HBR patients with and without DM after biodegradable polymer sirolimus-eluting coronary stent implantation. MethodsThis was a prespecified analysis from the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With a Abbreviated Versus Prolonged DAPT Regimen) trial, which randomized 4,579 HBR patients (1,538 [34%] with DM) to abbreviated (n = 2,295) or standard (n = 2,284) APT. The coprimary outcomes were net adverse clinical events (NACEs; composite of all-cause death, myocardial infarction, stroke, and major bleeding), major adverse cardiac or cerebral events (MACCEs; all-cause death, myocardial infarction, and stroke), and major or clinically relevant nonmajor bleeding at 11 months. ResultsHBR patients with DM had higher risks of MACCEs (HR: 1.28; 95% CI: 1.00-1.63) and similar net adverse or bleeding events compared with nondiabetic subjects. Abbreviated compared with standard APT was associated with similar NACEs and MACCEs (Pinteraction = 0.47 and 0.59, respectively) and reduced major or clinically relevant nonmajor bleeding (Pinteraction = 0.55) irrespective of diabetes status. ConclusionsMACCE and NACE rates were similar, and bleeding rates were lower with abbreviated APT in patients with or without diabetes. Therefore, diabetes status did not modify the treatment effects of abbreviated vs standard APT in HBR patients after biodegradable polymer sirolimus-eluting coronary stent implantation. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With a Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020)

THE CRITICAL CONNECTION BETWEEN ORAL HEALTH AND CARDIOVASCULAR WELL-BEING

The relationship between oral health and cardiovascular health has gained significant attention, particularly regarding the prevention of periodontal diseases to mitigate cardiovascular complications, especially in hypertensive patients. Periodontal diseases, including gingivitis and periodontitis, are chronic infections affecting the gums and supporting structures of teeth, potentially leading to systemic inflammation and the release of inflammatory mediators into the bloodstream. This chronic inflammation is associated with cardiovascular diseases, as it can contribute to plaque formation in arteries, increasing the risk of adverse cardiac events. Hypertension is a notable risk factor for cardiovascular diseases, and studies suggest that individuals with periodontal diseases are more likely to develop hypertension and related conditions. Therefore, proper prevention and treatment of periodontal diseases play a crucial role in the cardiovascular health of hypertensive patients. Early detection and intervention through periodontal screening programs can help reduce systemic inflammation and healthcare costs related to cardiovascular complications. Various studies support the positive effects of periodontal therapy on cardiovascular risk factors, indicating significant reductions in blood pressure and inflammatory markers following periodontal treatment. Furthermore, the alarming prevalence of hypertension, affecting approximately 45% of the global population, necessitates increased awareness of its links to periodontal health. Collaborative approaches between dentists and primary care physicians are essential to improve early detection and management of both periodontal and systemic health issues. Investing in preventive dental care not only enhances oral health but can also lead to substantial savings in healthcare costs by alleviating the financial burden associated with treating cardiovascular diseases. Ultimately, integrating oral health into broader health strategies is vital for promoting overall health and preventing chronic diseases.

CTCA Prior to Invasive Coronary Angiography in Patients With Previous Bypass Surgery: Patient-Related Outcomes, Imaging Resource Utilization, and Cardiac Events at 3 Years From the BYPASS-CTCA Trial.

In patients with previous coronary artery bypass grafting, computed tomography cardiac angiography (CTCA) before invasive coronary angiography (ICA) was demonstrated in the BYPASS-CTCA trial (Randomized Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) to reduce procedure time and incidence of contrast-associated acute kidney injury, with greater levels of patient satisfaction. Patient-related outcomes, utilization of further diagnostic imaging resources, and longer-term incidence of major adverse cardiac events were key secondary end points not yet reported. Patients with prior coronary artery bypass grafting referred for ICA were randomized 1:1 to undergo CTCA before ICA or ICA alone and followed up for a median of 3 (2.2-3.4) years. Angina status was assessed using the Seattle Angina Questionnaire and overall quality of life using the EQ-5D-5L. The incidence of noninvasive imaging use and major adverse cardiac events were compared between the 2 groups. In all, 688 patients were randomized, 344 to CTCA+ICA and 344 to ICA only. The mean age of participants was 69.8 years, with 45% undergoing ICA for acute coronary syndromes and the remainder stable angina. At 3 months follow-up, patients in the CTCA+ICA group were more likely to be angina-free (51.7% versus 43.2%; P=0.03) with greater quality of life (EQ-5D-5L index, 81.6 versus 74.4; P=0.001), although these improvements did not persist. At 3 years follow-up, imaging resource use (35.8% versus 45.1%; odds ratio, 0.68 [95% CI, 0.50-0.92]; P=0.013) and incidence of major adverse cardiac events were lower in the CTCA+ICA group (35.8% versus 43.5%; hazard ratio, 0.73 [95% CI, 0.58-0.93]; P=0.010). In patients with prior coronary artery bypass grafting undergoing ICA, CTCA before ICA leads to reductions in the use of imaging resources and the rate of major cardiac events out to 3 years, but with similar patient-related outcome measures. Together with the initial findings of BYPASS-CTCA, these data are supportive of routinely undertaking a CTCA before ICA in patients with prior coronary artery bypass grafting. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03736018.

The Impact of Intraoperative Transit-Time Flow Measurement on Off-Pump and On-Pump Bypass Surgery Based on Three Months: A Propensity Score Matching Study

Background: The goal of this study was to investigate how transit-time flow measurement (TTFM) parameters influenced the success of coronary bypass surgeries using the on-pump coronary artery bypass (ONCAB) and off-pump coronary artery bypass (OPCAB) techniques and to compare the rates of early graft failure and major adverse cardiac and cerebrovascular events (MACCE). Methods: We retrospectively analyzed subjects who underwent coronary bypass surgery at our institution between 2017 and 2023 and compared the TTFM data of patients divided into two groups based on the surgical method: ONCAB and OPCAB. We compared the postoperative and first three months' MACCE data to assess the impact of TTFM on the two surgical methods. Results: Of the 2032 patients who underwent coronary bypass, we analyzed data from 1540 patients in the ONCAB group and 194 patients in the OPCAB group. After propensity score matching, the TTFM data of 192 patients in both groups were compared. In the ONCAB group, a mean of 3.28 ± 0.7 grafts per patient was used, while 2.22 ± 0.6 grafts were used in the OPCAB group (p = 0.001). TTFM identified problems with 19 (4.7%) grafts in the ONCAB group and 29 (8%) grafts in the OPCAB group, leading to their revision (p = 0.001). Overall, the pulsatile index (PI) values in the OPCAB group were significantly higher than in the ONCAB group. Hospital mortality was 3.1% in the ONCAB group and 2.6% in the OPCAB group (p = 0.286). MACCE and graft failure rates were similar in the first three months. Conclusions: Utilizing TTFM to assess graft quality during surgery enhances coronary bypass surgery in both ONCAB and OPCAB procedures. The enhanced results are particularly crucial for a process like OPCAB surgery, which necessitates the expertise and experience of a surgeon and is challenging to execute.

Intravascular Lithotripsy in Acute Coronary Syndromes: Procedural and One-Year Clinical Outcomes From the BENELUX-IVL Registry.

Despite the excellent success and safety of intravascular lithotripsy (IVL) in heavily calcified lesions, evidence in acute coronary syndromes (ACS) remains limited. This study aimed to evaluate the procedural and clinical outcomes of IVL in heavily calcified ACS. Patients who underwent IVL between 2019 and 2024 from the ongoing prospective BENELUX registry were eligible for inclusion. Patients were therefore classified in ACS and chronic coronary syndrome (CCS) groups. The primary technical endpoint was angiographic success < 30%, defined as the successful delivery of the IVL catheter across the target lesion and delivery of IVL pulses without angiographic complications and residual target lesion less than 30%. The primary clinical endpoint was in-hospital major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, or target lesion revascularization. A total of 454 patients underwent IVL, with 251 (55.3%) treated for CCS and 203 (44.7%) for ACS. The median SYNTAX score (p-value 0.17), the need for inotropes (p-value 0.09), and the use of mechanical circulatory support (p-value 0.71) were similar between CCS and ACS groups. Comparable angiographic success (< 30% residual stenosis) was observed between CCS and ACS groups (90.1% vs. 91.1%, p = 0.69). MACE were similar across groups during hospital stays (CCS 1.6% vs. ACS 3.0%, p = 0.33), at 30 days (CCS 3.2% vs. ACS 3.9%, p = 0.86), and at 12-month follow-up (CCS 8.4% vs. ACS 7.9%, p = 0.91). IVL provides high procedural success and consistent clinical outcomes in both CCS and ACS cases.