Coronary Disease Research Articles

Preventing ischemic heart disease in women: a systematic review of global directives and policies

Cardiovascular disease is the leading cause of mortality in women worldwide. Yet cardiovascular disease in women remains underdiagnosed and undertreated, especially among vulnerable populations such as older women, low-income populations, and ethnic minorities. Resultantly, reduction in cardiovascular mortality among women has stagnated. To examine, consolidate current research findings and policies to identify gaps in women’s heart health practice, this review screened 21476 records and synthesized results from 124 English language publications worldwide. Using a life course approach, we assessed the connection between clinical recommendations and policy, and documented global recommendations and policies addressing prevention of cardiovascular disease in women. Key recommendations include fostering environments that encourage sustainable health behaviors for young women, advocating for national surveillance systems and guidelines for monitoring and increasing the understanding of cardiovascular health in high-risk pregnancy/postpartum groups, developing community prevention programs for midlife/menopause, and implementing direct population health management initiatives for elderly women, with an emphasis on higher risk groups. Inequalities still exist among women with varying socioeconomic status and race between countries, and even within countries.

Iatrogenic coronary artery dissection extending into the ascending aorta

One of the most feared complications of percutaneous coronary interventions is coronary artery dissection. Rarely, such dissections can propagate into the ascending aorta, which may then require surgical intervention. We present the case of a 50-year-old patient with new-onset angina and two-vessel coronary artery disease who underwent percutaneous coronary intervention on the right coronary artery, complicated by an iatrogenic coronary dissection extending into the ascending aorta. A decision was taken to perform emergent cardiac surgery due to ongoing chest pain and the extent of the dissection. Computed tomography after surgery revealed no signs of aortic dissection with normal dimensions in all aortic segments. The patient was discharged home in a stable condition.

Ultrasound-mediated cardiovascular thrombolysis: from Sonothrombolysis to Sonoperfusion.

The incidence of coronary artery disease has been increasing in recent years, with acute myocardial infarction as its most severe onset. The major aim for clinical treatment is to restore myocardial blood supply with the recanalization of coronary circulation as early as possible, while the still existed issue of microcirculation thromboembolism has become a serious obstacle. Thus, thrombus elimination in coronary microcirculation is crucial and essential to improve the treatment outcome of acute myocardial infarction. In recent years, from sonothrombolysis to sonoperfusion, ultrasound-mediated cardiovascular thrombolysis can effectively solve the problem of vascular thromboembolism, including microcirculation thromboembolism, and the treatment method is expected to obtain satisfied thrombolytic treatment effect with microthrombus elimination in coronary microvessels and function recovery of terminal microcirculation, which has potential clinical value for the establishment of novel treatment for coronary thromboembolism. Therefore, this paper reviews ultrasound-mediated cardiovascular thrombolysis including sonothrombolysis and sonoperfusion for the application exploration in the treatment of coronary artery thromboembolism, the mechanism of action, and its research progress.

Atherectomy Techniques: Rotablation, Orbital and Laser

Coronary artery disease remains the leading cause of morbidity and mortality worldwide despite advancements in percutaneous coronary intervention (PCI). With an increasing ageing population, there is a significant challenge in addressing severe calcification in atherosclerotic plaque during angioplasty. This review article focuses on atherectomy strategies such as rotational atherectomy (RA), orbital atherectomy (OA) and excimer laser coronary angioplasty (ELCA) aimed at modifying calcified lesions and improving PCI outcomes. RA modifies plaque through rotational ablation, OA uses eccentrically mounted diamond-coated crown and has a reduced entrapment risk compared to RA. ELCA uses pulsatile laser energy to precisely ablate plaque tissue. This review provides insights into the mechanisms, procedural techniques and clinical outcomes associated with these calcium modification techniques. The selection of appropriate devices and adequate training are crucial for optimising lesion modification and enhancing procedural success. Further research and standardised protocols are required to overcome challenges associated with using these devices and expand their usage in clinical practice.

Acute reperfusion therapies and prognosis in nonagenarian stroke patients.

Thrombolysis and endovascular thrombectomy (EVT) are standard treatments after stroke. We previously reported that these therapies benefit stroke patients over 80 years old. Now, we aim to study reperfusion therapies specifically in nonagenarians, hypothesizing a poorer prognosis in this group. Nonagenarian stroke patients were identified from our prospective monocentric cohort, which included consecutive patients >80 years old treated with thrombolysis and/or EVT from 2015-2019. Baseline characteristics, treatments and outcomes, as well as complications and mortality were analyzed. 96 nonagenarians were treated with thrombolysis (69.8%) and/or EVT (81.1%). 51% had a pre-stroke modified Rankin Score (mRS) ≤2. Cardioembolism was the most common etiology (67.7%). Age was associated with a higher mRS after stroke with a turning point at 90 years old : (90-99 years old: odds ratio (OR)=0.33, 95% confidence interval (95%CI):0.13-0.83, P=0.02) versus (85-89 years old: OR=0.72, 95%CI:0.34-1.50, P=0.38), and (80-84-year-old patients as the reference). In nonagenarians, previous coronary artery disease (OR=8.02, 95%CI:1.66-38.68, P=0.01), initial NIHSS (OR=1.11, 95%CI:1.03-1.19, P=0.01), pre stroke independence (OR=0.25, 95%CI:0.08-0.71, P=0.01) and 'drip-and-ship' status (OR=3.35, 95%CI:1.22-9.16, P=0.02) were associated with 3-month mortality. Nonagenarians had more baseline co-morbidities (P=0.003) and lower levels of pre-stroke independence (P=0.002) than octogenarians (n=261). Despite no difference in the use of acute treatments, timelines and rates of successful reperfusion, a good functional status at 3 months was less common in nonagenarians than octogenarians (14.3% versus 34.0%, P<0.001) with a higher mortality (60.2% versus 16.4%, P<0.001). 9.5% of nonagenarians experienced a symptomatic intracranial hemorrhage. Age is a crucial factor affecting prognosis after stroke with a turning point at 90 years old. However, age alone should not be a limiting factor for treatment decision. Despite higher mortality and poorer functional prognosis overall, some nonagenarians may benefit from reperfusion therapies.

Coronary computed tomographic angiography predicts crossing through chronic total occlusion within three guidewires

BackgroundCoronary computed tomography angiography (CCTA) is a valuable non-invasive method for the diagnosis and treatment of coronary artery disease, especially providing important clinical decision-making basis for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). However, there is no data to discuss whether CCTA can predict the success rate of crossing through occlusive lesions within 3 guidewires. ObjectiveThe aim of this study was to establish a scoring model based on CCTA images to predict the success rate of CTO-PCI within 3 guidewires for grading treatment difficulty. MethodsData including 267 CTO lesions in 252 patients with pre-procedural CCTA were analyzed. Successfully crossing through the lesion within 3 guidewires was set as a new endpoint to eliminate operator bias and estimate surgical costs. The Guidewires of CTO (GW-CTO) score was determined by assigning an appropriate integer point for each independent predictor of this endpoint and summing all points accrued. Results72.3% reached the new endpoint. We identified 5 predictors. Including blunt proximal stump, both proximal and distal branches, occluded segmental curvature>45°, length of occlusion≥20 mm, and calcified plaque burden≥0.125. With the GW-CTO score rising from 0 to 5, the success rate dropped from 98.83% to 12.50%. The CTO-PCI difficulty was stratified into three grades: easy (0–1), intermediate (2–3), and difficult (4–5). The GW-CTO score yielded good predictive results, with an area under receiver-operator characteristic (ROC) curve of 0.87. ConclusionThis model is very novel and presents a new perspective to predict the probability of successfully passing through CTO lesions within 3 guidewires. This may help grade the difficulty of CTO-PCI and determining the cost efficiency.

Association Between Clonal Hematopoiesis of Indeterminate Potential and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome Who Have Quit Smoking: Study Design of a Prospective Cohort Study

Abstract Despite quitting smoking, patients with acute coronary syndrome (ACS) still have an increased risk of cardiovascular events. Clonal hematopoiesis of indeterminate potential (CHIP), which may be induced by smoking, has been identified to be associated with the development of coronary artery disease. However, it is unclear whether CHIP has a detrimental effect on the poor prognosis of ACS patients even after smoking cessation. This single-center, prospective cohort study will recruit 1,029 ACS patients undergoing complete percutaneous coronary intervention. The enrolled patients will be categorized into 3 groups based on their smoking status at admission: current smoker, non-smoker, and previous smoker. Previous smokers are defined as patients who have quit smoking for at least 1 year before experiencing the index ACS event. Whole-exome sequencing will be performed to identify the occurrence of CHIP in each patient. The primary endpoint is major adverse cardiovascular and cerebrovascular events, defined as a composite of cardiac death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and ischemic stroke. The association between CHIP and the primary endpoint will be determined by using Cox proportional hazard regression. This study aims to investigate the association among smoking cessation, CHIP, and the prognosis of ACS patients to provide new insights into the impact of CHIP on ACS patients, particularly among those who have quit smoking. The results will be published following the STROBE in a peer-reviewed scientific journal (Trial registration number: NCT04987268).

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge Regarding Prevention of Coronary Artery Disease among Students In A Selected Arts College of Durg, Chhattisgarh (State)

Coronary artery disease is an obstructed blood flow through the coronary arteries to the heart muscles. The primary cause of coronary artery disease is atherosclerosis. The term acute coronary syndrome is used to encompass the continuum of coronary artery disease. Coronary artery disease is most prevalent type of cardiovascular disease in adults, more death occurs in middle aged adults. In India, even younger age group are prone to get heart disease due to their health damaging life style. This study was conducted to assess the effectiveness of video assisted teaching programme on knowledge regarding prevention of coronary artery disease among students in a selected arts college of Durg, Chhattisgarh (State) The conceptual framework used in this study was based on J.W.Kenney’s open system model. A quantitative approach was used for the present study. Using purposive sampling technique,60 arts students were selected and video assisted teaching given after pre-test. Followed by that post test was conducted on day 7, the collected data was analyzed using descriptive and inferential statistics. The overall analysis of prevention of coronary artery disease the mean post-test knowledge score of the subjects 28.07 is higher than the mean pre-test knowledge score 18.17. Thecalculated‘t’ value 19.769nis greater than of table value (1.984) at 0.001 level of significance. This indicates that video assited teaching programme was effective in gaining knowledge regarding the prevention of coronary artery disease. The association between socio demographic variables with pre-test knowledge score significance (p&lt;0.001) was tested. Based on the findings indicate that there is a significant difference between pre-test and post-test knowledge score on prevention of coronary artery disease in a selected arts college students at Durg.

High-dose atorvastatin and rosuvastatin reduce the levels of neutrophil extracellular trap-related proteins in coronary artery disease: association with prothrombotic state.

Neutrophil extracellular trap (NET) formation is involved in atherothrombosis. We sought to investigate whether statins affect neutrophil extracellular traps activation and release (NETosis) in coronary artery disease (CAD), and whether such changes show associations with statin‑induced additional effects. We studied 130 patients with advanced CAD before and at least 6 months after initiation of high‑dose statin therapy with rosuvastatin 40 mg/d or atorvastatin 80 mg/d. The levels of circulating citrullinated histone H3 (H3cit), myeloperoxidase (MPO), and neutrophil elastase (NE) were assessed as proteins associated with NETosis along with thrombin generation, plasma clot permeability (Ks), clot lysis time (CLT), and fibrinolysis inhibitors. Following statin therapy intensification, we observed reduced accumulation of H3cit (-30.4%), MPO (-28.1%), and NE (-25.5%; all P <0.001), all not associated with low‑density lipoprotein cholesterol (LDL‑C) lowering (-25%). However, H3cit level was lower in 50 patients (38.5%) who achieved the target LDL‑C below 1.8 mmol/l (-16.5%; P = 0.004), and in 19 patients (14.6%) with LDL‑C below 1.4 mmol/l (-25.5%; P = 0.001), as compared with the remaining individuals. The reductions in H3cit and MPO levels were associated with a 42.9% decrease in C‑reactive protein (CRP) level on high‑dose statins (R = 0.855; P <0.001 and R = 0.25; P = 0.004, respectively), along with increases in Ks and reduction in thrombin activatable fibrinolysis inhibitor (TAFI) activity, but not with CLT or thrombin generation (all |R|, 0.24-0.4; P <0.01). In multivariable analysis, changes in CRP (β = 0.771; P <0.001), TAFI activity (β = 0.125; P = 0.013), and fibrinogen level (β = 0.106; P = 0.034) were independently associated with a decrease in H3cit concentration. We showed for the first time that high‑dose statins can reduce the level of NET‑related proteins in association with anti‑inflammatory and antithrombotic actions in CAD patients.

Accelerated biological aging: unveiling the path to cardiometabolic multimorbidity, dementia, and mortality

BackgroundCardiometabolic multimorbidity (CMM) and aging are increasing public health concerns. This prospective study used UK Biobank cohort to investigate the relationship between biological aging and the trajectory of CMM to dementia and mortality.MethodsCMM is the coexistence of at least two cardiometabolic diseases (CMD), including stroke, ischemic heart disease, and diabetes. Biological age was calculated using the KDM-BA and PhenoAge algorithms. Accelerated aging indicated biological age advances more rapidly than chronological age.ResultsThe study included 415,147 individuals with an average age of 56.5 years. During the average 11-year follow-up period, CMD-free individuals with accelerated aging had a significantly greater risk of CMD (KDM-BA, HR 1.456; PhenoAge, HR 1.404), CMM (KDM-BA, HR 1.952; PhenoAge, HR 1.738), dementia (KDM-BA, HR 1.243; PhenoAge, HR 1.212), and mortality (KDM-BA, HR 1.821; PhenoAge, HR 2.047) in fully-adjusted Cox regression models (p &amp;lt; 0.05 for all). Accelerated aging had adjusted HRs of 1.489 (KDM-BA) and 1.488 (PhenoAge) for CMM, 1.434 (KDM-BA) and 1.514 (PhenoAge) for dementia, and 1.943 (KDM-BA) and 2.239 (PhenoAge) for mortality in participants with CMD at baseline (p &amp;lt; 0.05 for all). CMM significantly mediated accelerated aging’s indirect effects on dementia by 13.7% (KDM-BA, HR) and 21.6% (PhenoAge); those on mortality were 4.7% (KDM-BA) and 5.2% (PhenoAge). The population attributable-risk of Life’s Essential 8 score (≥80 vs. &amp;lt;80) were 0.79 and 0.43 for KDM-BA and PhenoAge accelerated aging, respectively.ConclusionBiological aging involves the entire trajectory of CMM from a CMD-free state to CMD, to CMM, and ultimately to dementia and death. Life’s Essential 8 may be a potential target to counter age acceleration.

Clearing the Air to Address Pollution's Cardiovascular Health Crisis.

Air pollution is a critical global health issue that significantly impacts cardiovascular health. The air pollutant PM2.5 (particulate matter with a diameter of 2.5 micrometres or less) has been positioned as a leading environmental risk factor for morbidity and mortality, especially from cardiovascular diseases (CVDs). Using data from the World Health Organization (WHO), Global Health Observatory, and the United Nations Environment Programme, we explored global trends in air pollution, with a focus on PM2.5 levels, the implications for cardiovascular health, and the policy measures aimed at reducing their impact. Despite progress in reducing pollution levels in high-income countries, global trends show a limited annual reduction in PM2.5 concentration. The analysis highlights disparities between regions, with low- and middle-income countries bearing the brunt of air pollution-related CVDs. In 2019 alone, ambient air pollution was responsible for approximately 4.2 million deaths worldwide. Of these, 70% were caused by CVDs, with approximately 1.9 million deaths from ischemic heart disease and 900,000 deaths from stroke. Policy gaps remain a challenge, with many countries lacking adequate legally binding air quality standards. We recommend the adoption of WHO air quality guidelines, enhanced monitoring of air pollution levels, and increased investment in interdisciplinary research to understand the full scope of air pollution's effects on cardiovascular health. Addressing the global cardiovascular crisis linked to air pollution will require coordinated efforts from policymakers, healthcare systems, and global health organisations.

Incidence of Diabetes and Ischemic Heart Disease in COVID-19 Post Pandemic

Background: The long-term effects of COVID-19 Pandemic are currently getting more attention. The majority of individuals with COVID-19 report having symptoms for duration greater than four weeks following their initial appearance. After COVID-19 infection, there is worry that cardiovascular conditions and metabolic conditions may be harmed. The severity of the sickness and COVID-19 vulnerability, meanwhile, are known to be linked to cardiometabolic risk. Aim: To study the incidence of ischemic heart disease and diabetes mellitus post COVID 19 pandemic Methods and Materials: Information for all individuals diagnosed as suffering of COVID-19 were taken at the beginning of the investigation from the health department's release of electronic medical records in February 2021. The main outcomes analyzed were first ever documented CVD as well as DM diagnoses. The data were then collected at different time periods. They were as follows: Before date of indexing. Acute: Follow up till four weeks from index. Post-acute: Five to twelve weeks from date of indexing. Long: Thirteen weeks to fifty-two weeks from date of indexing. Poisson confidence intervals (CIs) were computed. Results: CVD events was 1362 in COVID -19 study group while it was 131 in control study group at phase corresponding to four weeks after the indexed date. CVD events was 781 in COVID -19 study group while it was 298 in control study group at phase corresponding to five to twelve weeks since the date of indexing. CVD events was 781 in COVID -19 study group while it was 298 in control study group at phase corresponding to five to twelve weeks since the date of indexing. CVD events was 2,134 in COVID -19 study group while it was 298 in control study group at phase corresponding to 13 to 52 weeks since the date of indexing. Conclusion: Early on after COVID-19 infection, the risk of CVD is elevated, and this risk is elevated for up to three months. However, it was not observed that there was a long-term rise in the prevalence of CVD or DM in COVID-19 patients who do not already have these illnesses.

Ischemic Heart Disease; An Overview of Atypical Presentation &amp; Misdiagnosis

Cardiovascular disease is considered to be one of the main causes of death worldwide. The most common cardiovascular disease is ischemic heart disease (IHD). The cause of IHD is coronary blood flow reduction therefore also known as “coronary heart disease”. Incidence of IHD has been increase worldwide. IHD symptoms and sign range from typical classic chest pain to atypical e.g., epigastric discomfort and seizure. Patients present with atypical picture been misdiagnosed, this lead in delay of providing the appropriate care and treatment which will lead to worse outcomes and even death. In this review we are aiming to study the different clinical pictures of IHD mainly atypical presentation so patient can be treated earlier. Also, we are studying risk factors associated with IHD so can be managed as long as possible.

CCN5/WISP2 serum levels in patients with coronary artery disease and type 2 diabetes and its correlation with inflammation and insulin resistance; a machine learning approach

IntroductionStudies have shown various effects of CCN5/WISP2 on metabolic pathways, yet no prior investigation has established a link between its serum levels and CAD and/or T2DM. Therefore, this study seeks to explore the relation between CCN5 and the risk factor of CAD and/or diabetes, in comparison to individuals with good health, marking a pioneering endeavor in this field. MethodsThis case-control study investigates serum levels of CCN5, TNF-α, IL-6, adiponectin, and fasting insulin in a population of 160 individuals recruited into four equal groups (T2DM, CAD, CAD-T2DM, and healthy controls). Statistical tests comprise Chi-square tests, ANOVA, Spearman correlation, and logistic regression. ROC curves were used to represent the diagnostic potential of CCN5. Disease states are predicted by machine learning algorithms: Decision Tree, Gradient Boosted Trees, Random Forest, Naïve Bayes, and KNN. These models' performance was evaluated by various metrics, all of which were ensured to be robust by applying 10-fold cross-validation. Analyses were done in SPSS and GraphPad Prism and RapidMiner software. ResultsThe CAD, T2DM, and CAD-T2DM groups had significantly higher CCN5 concentrations compared to the healthy control group (CAD: 336.87 ± 107.36 ng/mL, T2DM: 367.46 ± 102.15 ng/mL, CAD-T2DM: 404.68 ± 108.15 ng/mL, control: 205.62 ± 63.34 ng/mL; P < 0.001). A positive and significant correlation was observed between CCN5 and cytokines (IL-6 and TNF-α) in all patient groups (P < 0.05). Multinomial logistic regression analysis indicated a significant association between CCN5 and T2DM-CAD, T2DM, and CAD conditions (P < 0.001) even after adjusting for gender, BMI, and age (P < 0.001). Regarding the machine learning models, the Naïve Bayes model showed the best performance for classifying cases of T2DM, achieving an AUC value of 0.938±0.066. For predicting CAD, the Random Forest classifier achieved the highest AUC value of 0.994±0.020. In the case of CAD-T2DM prediction, the Naïve Bayes model demonstrated the highest AUC of 0.981±0.059, along with an Accuracy of 97.50 % ± 7.91 % and an F-measure of 96.67 % ± 10.54 %. ConclusionOur study has revealed, for the first time, a positive connection between CCN5 serum levels and the risk of developing T2DM and CAD. Nonetheless, more research is needed to ascertain whether CCN5 can serve as a predictive marker.

Outcomes of Balloon-Expandable Transcatheter Aortic Valve Replacement in Younger Patients in the Low-Risk Era

Guidelines advise heart team assessment for all patients with aortic stenosis, with surgical aortic valve replacement recommended for patients younger than 65 years or with a life expectancy greater than 20 years. If bioprosthetic valves are selected, repeat procedures may be needed given limited durability of tissue valves; however, younger patients with aortic stenosis may have major comorbidities that can limit life expectancy, impacting decision-making. To characterize patients younger than 65 years who received transcatheter aortic valve replacement (TAVR) and compare their outcomes with patients aged 65 to 80 years. This retrospective registry-based analysis used data on 139 695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, inclusive of patients 80 years and younger undergoing TAVR from August 2019 to September 2023. Balloon-expandable valve (BEV) TAVR with the SAPIEN family of devices. Comorbidities (heart failure, coronary artery disease, dialysis, and others) and outcomes (death, stroke, and hospital readmission) of patients younger than 65 years compared to patients aged 65 to 80 years. In the years surveyed, 13 849 registry patients (5.7%) were younger than 65 years, 125 846 (52.1%) were aged 65 to 80 years, and 101 725 (42.1%) were 80 years and older. Among those younger than 65, the mean (SD) age was 59.7 (4.8) years, and 9068 of 13 849 patients (65.5%) were male. Among those aged 65 to 80 years, the mean (SD) age was 74.1 (4.2) years, and 77 817 of 125 843 patients (61.8%) were male. Those younger than 65 years were more likely to have a bicuspid aortic valve than those aged 65 to 80 years (3472/13 755 [25.2%] vs 9552/125 001 [7.6%], respectively; P < .001). They were more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. Patients younger than 65 years had worse baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs 52.9 [25.8], respectively; P < .001) and mean (SD) gait speed (5-meter walk test, 6.6 [5.8] seconds vs 7.0 [4.9] seconds, respectively; P < .001) than those aged 65 to 80 years. At 1 year, patients younger than 65 years had significantly higher readmission rates (2740 [28.2%] vs 23 178 [26.1%]; P < .001) and all-cause mortality (908 [9.9%] vs 6877 [8.2%]; P < .001) than older patients. When propensity matched, younger patients still had higher 1-year readmission rates (2732 [28.2%] vs 2589 [26.8%]; P < .03) with similar mortality to their older counterparts (905 [9.9%] vs 827 [10.1%]; P = .55). Among US patients receiving BEV TAVR for severe aortic stenosis in the low-surgical risk era, those younger than 65 years represent a small subset. Patients younger than 65 years had a high burden of comorbidities and incurred higher rates of death and readmission at 1 year compared to their older counterparts. These observations suggest that heart team decision-making regarding TAVR for most patients in this age group is clinically valid.

Causes of Coronary Angioplasty Denial in Patients Diagnosed with Significant Coronary Artery Disease in East Afghanistan

Coronary Artery Disease (CAD) is a leading cause of mortality worldwide, with coronary angioplasty being a crucial intervention for patients with significant disease. This study aimed to identify and analyze the causes of coronary angioplasty denial in patients with significant coronary artery disease in Afghanistan, focusing on demographic, socioeconomic, and clinical factors. A case-control study was conducted with a sample size of 213 patients diagnosed with significant CAD at tertiary care center in Afghanistan. The case group consisted of 106 patients who were denied angioplasty, and the control group included 107 patients who underwent the procedure. Data were collected on demographic characteristics, comorbidities, education, residence, functional status, income, and the reasons for angioplasty denial. Descriptive statistics and comparative analyses were performed to assess the factors associated with denial. The primary reasons for angioplasty denial were financial constraints (45.3%, p &lt; 0.001), limited hospital facilities (15.1%, p = 0.045), patient refusal (23.6%, p &lt; 0.001), and physician preference for conservative management (12.3%, p = 0.091). Denial rates were higher among patients who were older, had multiple comorbidities, were from rural areas, and had lower education and income levels. Illiteracy and cultural beliefs contributed significantly to patient refusal, while inadequate healthcare infrastructure disproportionately affected rural populations. Financial and infrastructural barriers are the leading causes of coronary angioplasty denial in Afghanistan, exacerbating disparities in healthcare access, particularly among low-income and rural patients. Addressing these issues through policy reforms, improved healthcare infrastructure, and targeted public health education is essential to reducing CAD-related morbidity and mortality in the country.

A Co-Culture System for Studying Cellular Interactions in Vascular Disease

Cardiovascular diseases (CVDs) are leading causes of morbidity and mortality globally, characterized by complications such as heart failure, atherosclerosis, and coronary artery disease. The vascular endothelium, forming the inner lining of blood vessels, plays a pivotal role in maintaining vascular homeostasis. The dysfunction of endothelial cells contributes significantly to the progression of CVDs, particularly through impaired cellular communication and paracrine signaling with other cell types, such as smooth muscle cells and macrophages. In recent years, co-culture systems have emerged as advanced in vitro models for investigating these interactions and mimicking the pathological environment of CVDs. This review provides an in-depth analysis of co-culture models that explore endothelial cell dysfunction and the role of cellular interactions in the development of vascular diseases. It summarizes recent advancements in multicellular co-culture models, their physiological and therapeutic relevance, and the insights they provide into the molecular mechanisms underlying CVDs. Additionally, we evaluate the advantages and limitations of these models, offering perspectives on how they can be utilized for the development of novel therapeutic strategies and drug testing in cardiovascular research.

Atrial fibrillation and multimorbidity: How to choose the perfect direct oral anticoagulant?

Atrial fibrillation is one of the most common tachyarrhythmias, the prevalence of which is steadily increasing due to an increase in the proportion of the elderly population. The presence of a comorbidities in elderly patients with atrial fibrillation, increasing the risk of thromboembolic events, has a significant impact on the clinical strategy of atrial fibrillation, as well as on the choice of therapeutic tactics, especially anticoagulant therapy with proven efficacy and low risk of bleeding. One of the most common concomitant diseases in patients with atrial fibrillation are chronic kidney disease, anemia and coronary artery disease. These comorbidities in patients with atrial fibrillation not only increase the risk of stroke and/or systemic embolism, but are also accompanied by an increased risk of cardiovascular mortality, all causes mortality, and hemorrhagic events. At the same time, according to research data, about half of polymorbid patients with atrial fibrillation do not receive anticoagulant therapy, which indicates a low awareness of physicians about rational pharmacotherapy based on clinical recommendations for this cohort of patients. The drug of choice with the most studied safety profile and a high degree of efficacy in these patients is apixaban from the group of direct oral anticoagulants. Unlike vitamin K antagonists and other representatives of direct oral anticoagulants, apixaban, according to the conducted studies, is associated with a more significant reduction in the risk of thromboembolic events, and most importantly, has a lesser effect on the risks of bleeding in patients, predisposing to hemorrhagic complications, with atrial fibrillationand concomitant coronary artery disease, anemia, chronic kidney disease.

Enhanced CAD Detection Using Novel Multi-Modal Learning: Integration of ECG, PCG, and Coupling Signals

Early and highly precise detection is essential for delaying the progression of coronary artery disease (CAD). Previous methods primarily based on single-modal data inherently lack sufficient information that compromises detection precision. This paper proposes a novel multi-modal learning method aimed to enhance CAD detection by integrating ECG, PCG, and coupling signals. A novel coupling signal is initially generated by operating the deconvolution of ECG and PCG. Then, various entropy features are extracted from ECG, PCG, and its coupling signals, as well as recurrence deep features also encoded by integrating recurrence plots and a parallel-input 2-D CNN. After feature reduction and selection, final classification is performed by combining optimal multi-modal features and support vector machine. This method was validated on simultaneously recorded standard lead-II ECG and PCG signals from 199 subjects. The experimental results demonstrate that the proposed multi-modal method by integrating all signals achieved a notable enhancement in detection performance with best accuracy of 95.96%, notably outperforming results of single-modal and joint analysis with accuracies of 80.41%, 86.51%, 91.44%, and 90.42% using ECG, PCG, coupling signal, and joint ECG and PCG, respectively. This indicates that our multi-modal method provides more sufficient information for CAD detection, with the coupling information playing an important role in classification.

Fast simulation of coronary in‐stent restenosis: A non‐intrusive data‐driven reduced order surrogate model

AbstractModeling and simulation of coronary artery disease (CAD) is of great importance for supporting and predicting the outcome of percutaneous coronary intervention (PCI). However, an in silico model generally requires heavy computational resources. An effective reduced order surrogate model is indispensable in this context. This study aims to develop a non‐intrusive data‐driven reduced order surrogate model for coronary in‐stent restenosis (ISR) incorporating anti‐inflammatory drugs embedded in the drug‐eluting stents. The constitutive model includes a detailed multiphysics approach based on partial differential equations (PDEs), which include descriptions of platelet aggregation, growth‐factor release, cellular motility and drug deposition. Dimensionality reduction is carried out based on a 3D convolutional autoencoder, which comprises an encoder and decoder. The former condenses the full‐order solution into a lower‐dimensional latent space, while the latter recovers the full solution from the latent space. Special attention is paid to handle the multidimensional outputs and network architecture.