Coronary Artery Involvement Research Articles

Clinical characteristics of coronary artery involvement in children with Behcet's syndrome.

To review the clinical features, treatment, and prognosis of coronary involvement in Behcet's syndrome in children. Retrospectively analyzed medical records of BS patients admitted to our institution from 2012 to 2024. Six children with BS with coronary involvement were admitted, including 2 males and 4 females. The mean age was 5.7years and the mean course was 17.2months. All of them had coronary dilatation, including 1 case with aneurysmal dilatation, 2 cases with bilateral coronary dilatation, 4 cases with unilateral dilatation, and 4 cases with valvular disease. No symptom for coronary artery dilation and all of coronary dilatation were detected by echocardiography. Manifestations of extracardiac vascular involvement included arteriovenous wall thickness and thrombosis. Five cases had only arterial involvement and one case had both artery and vein involvement. Pulmonary artery was involved in 1 case. All of them were treated with glucocorticoid and immunosuppressant, 1 child was treated with TNF-α, and 1 received aortic valvuloplasty due to a large number of aortic regurgitations. The patient with coronary aneurysm died suddenly after giving up treatment, and the other 4 cases were all improved to varying degrees. Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. Patients with coronary involvement are occultic and difficult to diagnose. Both arteries and veins can be involved, and some patients have severe symptoms. Clinicians should attach great importance to early vascular screening, especially coronary artery. Early combined medication may help improve the prognosis. Key Points • Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. • Coronary involvement in BS is rare in children, which is predominantly coronary dilatation. • The onset of BS with coronary involvement is insidious and easy to be missed, so early coronary artery screening in children with BS should be emphasized. • Early combined medication may help improve the prognosis of BS with coronary involvement.

Investigating the Relationship Between Cigarettes and Hookah Smoking with Coronary Artery Disease

Background: Cardiovascular disease (CVD) is recognized as a leading global cause of mortality, with tobacco use being one of the established risk factors responsible for 29% of related deaths. Although tobacco smoking, particularly through hookah, is increasing globally, limited data are available to evaluate its impact on CVD. This study aimed to investigate the relationship between cigarette and hookah smoking and coronary artery disease (CAD). Objectives: This study evaluated the relationship between cigarette and hookah smoking and coronary artery involvement based on coronary angiography findings. Methods: In this hospital-based cross-sectional study, 256 patients were included, with 128 patients in the CAD group (showing at least 50% stenosis in the left main artery or over 70% stenosis in other coronary arteries) and 128 patients in the normal angiography group. We assessed their smoking status, categorizing participants as current smokers, ex-smokers, or never-smokers. To ensure the collection of accurate and reliable data, we conducted face-to-face interviews, observations, and administered a questionnaire and medical checklist. Results: Based on multivariable logistic regression models, after adjusting for additional risk factors, individuals who smoked exhibited an approximately eight-fold higher likelihood of developing CAD compared to non-smokers. Additionally, hookah users showed a five-fold increase in CAD risk compared to non-hookah users (P = 0.001). Conclusions: Cigarette and hookah smoking are significantly associated with CAD, with cigarette smoking showing a comparatively stronger association with CAD than hookah use when considering other risk factors.

Corticosteroid effects on IL-10 and IL-1β in U937-derived macrophages: A model for Kawasaki disease-associated inflammation

BackgroundKawasaki disease (KD) is a pediatric vasculitis that has a predilection for coronary artery involvement. Activated macrophages play an important role in the destruction of the coronary arteries in KD. Although intravenous immunoglobulin (IVIG) is standard therapy, corticosteroids are sometimes given to patients at a higher risk of IVIG non-responsiveness. In this study, we examined the effect of IVIG and corticosteroids in U937 derived M1 and M2 a macrophages. MethodsA total of 40 children with KD and 30 healthy controls were enrolled. U937-derived macrophages were stimulated with patient plasma to examine its effect on macrophage polarization. U937 derived M1 and M2 macrophages were then stimulated with IVIG and methylprednisolone. RNA was extracted from cell cultures and the expression levels of STAT1, interleukin (IL)-1β, PPARγ and IL-10 were determined by RT-PCR. ResultsIVIG was effective at suppressing IL-10 expression in M2 macrophages (relative mRNA expression mean ± SE, high dose IVIG Vs. untreated 0.304 ± 0.095 Vs. 2.541 ± 0.157, p = 0.002), but did not suppress the production of IL-1β in M1 macrophages. In contrast, methylprednisolone both suppressed the IL-1β in M1 macrophages and also enhanced IL-10 in M2 macrophages even at low doses (relative mRNA expression mean ± SE, low dose methylprednisolone Vs. untreated IL-1β 6.353 ± 0.414 Vs. 93.838 ± 1.321, p < 0.001, IL-10 61.117 ± 2.319 Vs. 46.867 ± 2.893, p = 0.005). DiscussionIn this study we found that methylprednisolone was effective at suppressing the inflammatory cytokine IL-1β in M1 macrophages, and enhanced the production of anti-inflammatory IL-10 in M2 macrophages, an effect that could not be produced by IVIG. Our findings provide further mechanistic evidence that corticosteroid therapy, even at low doses may be a cost-effective adjuvant to IVIG therapy in patients with high-risk KD.

The Hypothesis of Trace Elements Involvement in the Coronary Arteries Atherosclerotic Plaques' Location.

Background: Coronary artery disease (CAD) is a chronic inflammatory disease with multiple well-known risk factors. Although epidemiological studies report improvements in classical CAD risk-factor control, except for diabetes and obesity, cardiovascular diseases remain the leading causes of morbidity and mortality in the current population. The question regarding the atherosclerotic plaque location in particular arteries remains unanswered. Research on novel possible aspects that could help to properly understand atherosclerosis pathophysiology is essential. This study was based on a body trace-elements analysis, measured in scalp hair samples, as possible co-factors of various enzymes that may be crucial for CAD development. Methods: A total of 133 consecutive male patients with a median age of 71 (65-75) years, who presented with anginal symptoms of CCS class 2.0 (0.3) without previous heart-related interventions, were included in the analysis. The results of the cine-angiography were compared with the demographical, clinical, and laboratory results, followed by scalp-hair trace analysis. The possible predictors for coronary disease locations in the left descending artery (LAD), the circumflex artery (Cx), and the right coronary artery (RCA) were the subjects of this study. Results: Statistically significant differences in the scalp-hair trace elements concentration between the CAD and normal angiogram groups were noticed for magnesium (p = 0.003), calcium (p < 0.001), chromium (p = 0.011), and copper (p = 0.043). The multivariable analysis for epicardial atherosclerotic disease revealed the co-existence of diabetes mellitus (OR: 2.94, 95% CI: 1.27-6.79, p = 0.012) as a possible causative factor for the LAD location. The multivariable analysis for the atherosclerosis location in the Cx artery presented scalp-hair magnesium as a possible predictive factor (OR: 0.98, 95% CI: 0.96-1.00, p = 0.024). The multivariable model for the RCA location of atherosclerotic plaque indicated scalp-hair Zn concentration (0.99, 95% CI: 0.98-1.00, p = 0.002) and serum HDL (OR: 0.61, 95% CI: 0.04-0.09, p = 0.016). Conclusions: Possible hypothetical distinctive pathomechanisms, in particular, coronary artery involvement, in atherosclerosis processes are presented in the male group. Diabetes mellitus was found to be the primary factor for left descending artery disease. The low scalp-hair magnesium concentration was found to be a possible risk factor involved in the circumflex artery atherosclerotic plaque location. The inverse relation between serum high-density lipoprotein, the scalp hair zinc concentration, and right coronary disease was noticed.

Cold agglutinin disease coexisting with left main coronary artery involvement and ventricular dysfunction — a challenging triad

Cold agglutinin disease coexisting with left main coronary artery involvement and ventricular dysfunction — a challenging triad

Factors Associated with Shock at Presentation in Kawasaki Disease Versus Multisystem Inflammatory Syndrome in Children Associated with COVID-19

While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups. The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from 01/2020 to 01/2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis/shock groups. Shock at presentation was noted for 19 of 672 (2.8%) KD patients and 653 of 1472 (44%; p<0.001) MIS-C patients. Within both groups, patients with shock were significantly more likely to be admitted to the intensive care unit, receive inotropes and to have greater laboratory abnormalities indicative of hyperinflammation and organ dysfunction, including abnormal cardiac biomarkers. Patients with KD and shock had a greater maximum coronary artery Z score (median +2.62) versus KD patients without shock (+1.36; p<0.001) and MIS-C patients with shock (+1.45; versus +1.32 for those without shock; p<0.001). They were also more likely to have large coronary artery aneurysms. In contrast, MIS-C patients with shock had lower left ventricular ejection fraction (mean 51.6%) versus MIS-C patients without shock (56.6%; p<0.001) and KD patients with shock (56.7%; versus 62.8% for those without shock; p=0.04). While patients with KD presenting with shock are clinically similar to patients with MIS-C, especially those with shock, they have more severe coronary artery involvement, while MIS-C patients with shock have lower left ventricular ejection fraction.

Specific Morphology of Coronary Artery Aneurysms in Mainly White Patients With Kawasaki Disease: Initial Data From the Cardiac Catheterization in Kawasaki Disease Registry.

Patients with Kawasaki disease (KD) with coronary artery involvement require long-term cardiac care. Although respective evidence-based recommendations are missing, cardiac catheterization is still considered the gold standard for diagnosing detailed coronary pathology. Therefore, to better understand coronary artery pathology development, we conducted a survey to document and evaluate cardiac catheterization data in a European population. We retrospectively analyzed cardiac catheterization data from KD children from the year 2010 until April 2023. This registry covers basic acute-phase clinical data, and more importantly, detailed information on morphology, distribution, and the development of coronary artery pathologies. A total of 164 mainly White patients (65% boys) were included. A relevant number of patients had no coronary artery aneurysm (CAA) at the cardiac catheterization, indicating that distal CAAs were almost exclusively detected alongside proximal CAAs. Patients with multiple CAAs revealed a significant positive correlation between the number of CAAs and their dimensions in diameter and in length. Location of the CAA within the coronary artery, age at onset of KD, or natal sex did not significantly influence CAA diameters, but CAAs were longer in older children and in boys. That distal CAAs were only present together with proximal ones will hopefully reduce diagnostic CCs in patients with KD without echocardiographically detected proximal CAAs. Furthermore, this study gives valuable insights into dimensional specifics of CAAs in patients with KD. As an ongoing registry, future analyses will further explore long-term outcomes and performed treatments, helping to refine clinical long-term strategies for patients with KD. URL: https://drks.de/; Unique Identifier: DRKS00031022.

CD8 cell-derived granzyme B may be a predictor for Coronary artery involvement and MACE in Takayasu arteritis patients.

Coronary artery involvement (CAI) is a special but not rare manifestation of Takayasu arteritis (TAK). Granzyme B (GzmB) is a multifunctional protease associated with the immune system and coronary artery disease. However, its role in patients with TAK and CAI remains unclear. This study investigates the role of GzmB+ cell subsets in TAK. The study included 105 TAK patients and 58 healthy controls. The percentages of different GzmB+ cells in blood samples were analyzed by flow cytometry. We found that age, age at onset, BMI, disease duration month, hypertension, and hyperlipidemia were significantly different between TAK patients with and without CAI (P=0.000, P=0.038, P=0.003, P=0.031, P=0.039, P=0.000). The proportions of CD3+CD8+cells (P=0.001) and CD3+CD4+cells (P=0.000) in GzmB+ cells were significantly increased, while the proportion of CD3-CD56+cells (P=0.001) in GzmB+ cells was decreased in TAK patients. The proportions of three types of GzmB+ subsets in lymphocytes (CD3+CD4+GzmB+, CD3+CD8+GzmB+, CD3+CD56+ GzmB+) were higher in TAK patients with CAI compared to those without CAI (P=0.021, P=0.007, P=0.007). The increased proportion of CD3+CD8+GzmB+cells/lymphocytes was an independent risk factor for coronary involvement in TAK (OR=4.990 [1.766-14.098], P=0.002). Additionally, patients with a high CD3+CD8+GzmB+cells/lymphocytes ratio had a higher MACE rate than those with a low ratio in TAK (P=0.019). Our results indicate that CD8 cell-derived Gzm B may be a predictor for CAI and MACE in TAK patients. Targeting CD3+CD8+GzmB+ lymphocytes or using GzmB inhibitors could be a potential therapeutic approach for the treatment of CAI in TAK.

Usefulness of percutaneous transluminal coronary balloon angioplasty for coronary artery stenosis after surgery for CHD.

Coronary artery involvements occur rarely both during cardiac repair and in the late period after surgery, and it may result in myocardial ischaemia and infarction. We present six cases who underwent percutaneous transluminal coronary balloon angioplasty for coronary artery stenosis in the late period after surgery. The patients included four boys and two girls. Post-operative states involving anomalous origin of the left coronary artery from the pulmonary artery and d-transposition of the great arteries were observed in two patients each. Two patients with univentricular heart had coronary artery injuries during surgery. The age at the angioplasty ranged from 1 month to 14 years, with a median of 3 years. The interval from the operation to angioplasty ranged from 37 days to 14 years (median 8 months). The interval from the angioplasty to follow-up coronary angiography ranged from 2 months to 14 years (median 11 months). The follow-up period ranged from 2 months to 20 years (median 8 years). One patient underwent a stent implantation because of post-procedure recoil. Coronary artery stenosis improved immediately after procedure in the six patients without complication, and restenosis occurred post-procedure in one patient. Five patients had no cardiac events. Although the angioplasty's initial effect may not be dramatic, it can improve late after the procedure. It was considered that the optimal balloon-reference vessel ratio to obtain a minimal effective lumen diameter was about 1.0. Angioplasty post-surgery for CHD in children was feasible and without complications.

Predictors of Isolated Coronary Artery Ectasia (CAE) in Egyptian Population

Abstract Background Coronary artery ectasia (CAE) is defined as a dilation of ≥ 1.5-fold compared to the diameter of adjacent normal segments of the same or other arteries. The term 'ectasia' refers to the diffuse dilation of a coronary artery, while focal coronary dilation is referred to as 'coronary aneurysm'. The exact pathophysiology of CAE remains unknown. Objective To evaluate risk factors and clinical criteria as predictors of isolated coronary artery ectasia in the Egyptian population referred to our Cath laboratory for coronary angiography. Patients and Methods This Retrospective Study was carried out at our Cath lab at Misr University for Science and Technology (MUST) hospital. Among patients attending Souad Kaafi University Hospital, undergoing coronary angiography from November 2018 to October 2022 that 2100 patients, we found 40 patients with isolated coronary artery ectasia who enrolled in this study, and 252 patients with normal coronary angiography as a control group. Results The multivariate logistic regression analysis to assess predictors of the incidence of CAE among the studied patients shows that the most important associated factor that affected the incidence of CAE was smoking with an odd ratio of 7.769 and 95% CI (3.311- 18.229). Among patients with isolated coronary artery ectasia, on the number of affected vessels, Smoking status was significantly associated with the extent of coronary artery involvement, with a significant decrease in the proportion of smokers from the three-vessel group (84%) to the two-vessel group (42.9%) and the single-vessel group (0%) (p = 0.000). Among patients, there was statistical significance between isolated coronary artery ectasia and multiple vessel affection. Conclusion This study revealed that smoking is significantly associated with the presence of coronary artery ectasia (CAE), while diabetes mellitus (DM) and smoking showed a potential link to more extensive coronary artery involvement. Although other cardiovascular risk factors did not show significant associations, most patients with isolated CAE demonstrated involvement of multiple coronary vessels.

Electrocardiographic Changes in Pediatric Patients with COVID-19

Abstract Background COVID-19 may present with cardiac involvement such as shock, elevated troponin or, pro- brain natriuretic peptide level, coronary artery involvement, ventricular dysfunction, and arrhythmia. The most frequent electrocardiographic findings are low QRS amplitude, nonspecific ST segment changes and T-wave abnormalities. PR interval prolongation and first-degree AV block are also common in patients with MIS-C. Aim of the Study To evaluate the electrocardiogram changes in pediatric patients with COVID-19. Patients and Methods The present study is a cross sectional study which included 75 patients with definite, probable or evidence of previous COVID-19 infection (based on positive PCR, IgM or IgG), who were admitted at El Demerdash Pediatrics Hospital. Each child had two electrocardiogram done (on presentation and on third day of admission). Results The median age of our population was five years. Thirty five were females and fourty were males. On presentation, our patients had regular rythm, bradycardia was found among 9 patients (12%) and tachycardia was found among 17 patients (22.7%). Four patients (5.3%) showed prolonged PR interval, one patient (1.3%)showed prolonged QRS complex, one patient showed Right axis deviation and four patients (5.3%) showed left axis deviation, prolonged QT interval was found among four patients(5.3%). Regarding T wave, there was inversion in V1 in 27 patients(37.5%) and inversion in v4 in 24 patients(32.9%). All these findings disappeared with follow up on day three of admission. Conclusion Electrocardiogram may represent a crucial test in the diagnosis of myocardial injury or heart rythm disturbances in patients with SARS-COV-2.

Childhood-onset versus adult-onset Takayasu arteritis: A study of 239 patients from China

ObjectiveWe aimed to compare clinical features, vascular involvement, disease activity, and management between Chinese patients with childhood-onset Takayasu arteritis (cTAK) and adult-onset Takayasu arteritis (aTAK). MethodsIn total, 239 patients with TAK from the pediatric and adult rheumatology departments of two tertiary care centers were retrospectively evaluated. Data on demographic characteristics, laboratory results, disease activity, vascular involvement, and management regimens were collected and compared between the cTAK and aTAK patients. ResultsIn total, 85 cTAK and 154 aTAK patients were enrolled. There was a significant difference in the female/male ratio between the cTAK and aTAK groups (2.3:1 vs. 10.8:1, P<0.001). Fever, hypertension, arrhythmia, and heart failure were more frequent in the cTAK group. The median Indian Takayasu Clinical Activity Score-scores were significantly higher in the cTAK group compared to the aTAK group (5 vs. 3, P=0.004). The prevalence of supra-aortic artery involvement was significantly higher in the aTAK group than in the cTAK group (P<0.05). The rate of involvement of coronary and renal arteries was significantly lower in the aTAK group than in the cTAK group (P<0.05). Compared to the aTAK patients, the cTAK patients were more likely to be treated with biological agents (76.5% vs. 9.1%, P<0.001). ConclusioncTAK patients had more severe disease and inflammation. Coronary and renal artery involvement was more common among cTAK patients, whereas supra-aortic artery involvement was more common in aTAK patients increasing their risk of cerebral infarction. Biologics were used more frequently in cTAK patients.

Uncommon presentation of acute type A aortic dissection: sleeve-severed and everted proximal right coronary artery intima without myocardial ischaemia

BackgroundType A aortic dissection (TAAD) with coronary involvement is rare but potentially fatal. Proper myocardial protection during surgery is essential.Case presentationHere, we describe a 52-year-old woman who presented with sudden chest pain. CT angiography revealed TAAD with right coronary artery involvement. During surgery, the proximal intima of the right coronary artery was found to be completely severed and everted. Conventional myocardial perfusion methods were inadequate. A patented perfusion tip for coronary artery orifice perfusion was used, resulting in favourable surgical outcomes. The patient was discharged without complications.ConclusionsThis case emphasizes the need for careful preoperative assessment of coronary involvement in TAAD patients. The myocardial protection method used here is very helpful and can be applied effectively in similar cases encountered by surgeons.

Multi-modal immune dynamics of pre-COVID-19 Kawasaki Disease following intravenous immunoglobulin

Despite progress, the molecular mechanisms underlying Kawasaki Disease (KD) and intravenous immunoglobulin's (IVIG) ability to mitigate the inflammatory process remain poorly understood. To characterize this condition, plasma proteomic profiles, flow cytometry, and gene expression of T cell subsets were investigated in longitudinal samples from KD patients and compared with two control groups. Systems-level analysis of samples in the acute phase revealed distinctive inflammatory features of KD, involving mainly Th-1 and Th-17 mediators and unveiled a potential disease severity signature. APBB1IP demonstrated an association with coronary artery involvement (CAI) and was significantly higher in CAI+ compared to CAI- patients. Integrative analysis revealed a transient reduction in CD4+ EM T cells and a comprehensive immune activation and exhaustion. Following treatment, Tregs at both frequency and gene expression levels revealed immune dynamics of recovery. Overall, our data provide insights into KD, which may offer valuable information on prognostic indicators and possible targets for novel treatments.

The changes of coagulation profiles in Kawasaki disease and its associations with clinical classification, intravenous immunoglobulin responsiveness and coronary artery involvement

Coagulation disorders are common in Kawasaki disease (KD). The main objectives of the present study were to probe the associations of coagulation profiles with clinical classification, IVIG responsiveness, coronary artery abnormalities (CAAs) in the acute episode of KD. A total of 313 KD children were recruited and divided into six subgroups, including complete KD (n = 217), incomplete KD (n = 96), IVIG-responsive KD (n = 293), IVIG-nonresponsive KD (n = 20), coronary artery noninvolvement KD (n = 284) and coronary artery involvement KD (n = 29). Blood samples were collected within 24-h pre-IVIG therapy and 48-h post-IVIG therapy. Coagulation profiles, conventional inflammatory mediators and blood cell counts were detected. Echocardiography was performed during the period from 2- to 14-day post-IVIG infusion. In addition, 315 sex- and age-matched healthy children were enrolled as the controls. (1) Before IVIG therapy, coagulation disorders were more prone to appear in KD patients than in healthy controls, and could be overcome by IVIG therapy. FIB and DD significantly increased in the acute phase of KD, whereas reduced to normal levels after IVIG therapy. (2) PT and APTT were significantly longer in patients with complete KD when compared with their incomplete counterparts after IVIG therapy. (3) The larger δDD, δFDP and the smaller δPT, δINR predicted IVIG nonresponsiveness. (4) The higher δDD and δFDP correlated with a higher risk for CAAs (DD: r = −0.72, FDP: r = −0.54). Coagulation disorders are correlated with complete phenotype, IVIG nonresponsiveness and CAA occurrence in the acute episode of KD, and can be rectified by synergistic effects of IVIG and aspirin.

Dressler - de Winter sign with acute inferoposterior STEMI: An ECG dilemma in artery localization

The Dressler-de Winter sign is an electrocardiogram (ECG) pattern characterized by upsloping ST-segment depression in leads V1-V6 followed by tall, hyperacute T waves, typically indicating an occlusion of the left anterior descending artery (LAD). We present a case involving an inferoposterior ST-segment elevation myocardial infarction (STEMI) with a variant of the de Winter sign, a concept of ST-segment continuum in the precordial leads. Despite initial ECG findings suggesting right coronary artery (RCA) or left circumflex artery (LCX) involvement, coronary angiography confirmed occlusion of the wrap-around LAD distal to the first septal (S1) and diagonal branch (D1) and revealed a left dominant system accompanied by a small non-dominant RCA. This case highlights the diagnostic complexity in accurately localizing the culprit artery in STEMI cases exhibiting the de Winter sign. Understanding such ECG variants is crucial for analyzing the mechanisms of acute ischemia and ensuring accurate assessment of the culprit vessel for effective revascularization.

Routine Coronary Angiography and Functional Cardiac Tests before Resection of Abdominal Aortic Aneurysm in Patients without Symptoms of Myocardial Infarction

INTRODUCTION: Cardiac complications are leaders in the structure of mortality of patients after resection of abdominal aortic aneurysms (AAA). In recent years more data have been obtained on the possibility of performing invasive coronary angiography (CAG) as a method of preoperative assessment of the condition of the coronary arteries. AIM: To assess the tactics of routine CAG and preventive revascularization of the myocardium in comparison with non-invasive functional tests in patients without clinical manifestations of coronary heart disease (CHD) from positions of the hospital outcomes of AAA resections. MATERIALS AND METHODS: A retrospective study included 205 patients without clinical and instrumental signs of CHD who underwent AAA resection at National Medical Research Center of Surgery named after A. Vishnevsky in 2001–2021. Patients of the first group (n = 55) underwent CAG before AAA resection and, if significant stenosis of coronary arteries was detected, revascularization of the myocardium was performed. In patients of the second group (n = 71), only functional cardiac tests were conducted before the operation. Patients of the third group were operated on without additional evaluation of cardiac status. RESULTS: In 30.9% of patients of the first group, significant coronary lesions were detected, in 29.5% of them with the involvement of the left main coronary artery. This required 10 percutaneous coronary interventions and 5 coronary artery bypass surgeries, which made 27.0% of patients in this group. No cases of myocardial infarction were recorded in this group. In the second and third groups, one case of myocardial infarction in each group was recorded (p = 0.688). There was no significant difference in the postoperative mortality in all the groups (1.8%; 4.2%; 2.5%, respectively; p = 0.704). To this end, maximally invasive diagnostic tactics increased the average waiting time for AAA resection: 52.2 ± 6.0 days in groups without coronary angiography and myocardial revascularization versus 99.2 ± 13.0 days in the first group. CONCLUSION: In a cohort of patients without anamnestic and clinical manifestations of coronary artery disease, the tactics of routine coronary angiography followed by prophylactic myocardial revascularization did not improve the short-term results of AAA resection, while the waiting period for intervention on the abdominal aorta increased. Preoperative tactics with functional cardiac tests also did not affect the treatment results.

MIS-C Treatment: Is glucocorticoid monotherapy enough for mild cases?

BackgroundThe effectiveness of using only glucocorticoids (GCs) in mild multisystem inflammatory syndrome (MIS-C) cases was compared with combined treatment [GCs + Intravenous immune globulin (IVIG)]. MethodsThis retrospective cohort study was conducted between June 1, 2020, and June 1, 2022, in a tertiary care center in Istanbul, Turkey. Clinical and investigational data of the MIS-C patients were analyzed. The patients were divided into two groups: those who received only GCs and those who received the GCs + IVIG combination. The primary outcome focused on assessing the deterioration of the patient's clinical condition, the occurrence of shock, admission to the pediatric intensive care unit (PICU), and the need for additional immunosuppressive medication. Secondary outcomes included evaluating the course of cardiovascular and infection-related complications observed at the one-year follow-up. ResultsNinety-seven MIS-C patients with a median age of 41 (3‐ 214) months were enrolled. Fifty-six (57.7%) patients were male. All the patients had fever at admission with a temperature of 39 °C (37.5 °C–40.1 °C). Thirty-two patients (33%) had cardiac findings on echocardiography [left ventricular dysfunction (n= 13, 13.5%), coronary artery involvement (n= 11, 11.3%), and dilation of cardiac cavities and/or increased cardiac muscle thickness (n= 8, 8.2%)]. Thirteen patients (13.5%) required intensive care. All patients received GCs [only GCs (group I; n= 65, 67%)], and 32 patients (33%) with severe manifestations and/or cardiac involvement received GCs + IVIG (group II). No mortality was observed. None of the patients had any complaints at the one-year follow-up, and all echocardiography findings were normal. ConclusionThis study provides preliminary evidence that GC monotherapy is a safe treatment alternative for mild MIS-C cases without cardiac involvement.

Is the prevalence of risk factors, clinical presentations and severity of coronary artery diseases (CAD) in patients with very early and premature CAD are different from mature CAD patients?: A registry- based cross-sectional study

IntroductionThe present study aims to compare the risk factors, clinical presentation, and severity of coronary artery involvement in young compared to elderly CAD patients to assess the cardiovascular health status for better disease management and control of these specific patients. MethodsThis registry-based cross-sectional study was conducted using Coronary Angiography and Angioplasty Registry (CAAR) patients in east of Tehran, Iran. The data were extracted from 330 patients with confirmed CAD recorded by the CAAR during July 2021 to August 2023. ResultsThe majority of patients in MCAD (68.2%) and VECAD (80%) were male, while the majority of PCAD patients were female (51.8%). Among PCAD patients, the prevalence of diabetes (38.1%) was higher than in other groups. The presence of IHD history in the father (38.1%) and mother (26.3%) was higher in the VECAD group. The mean total cholesterol, LDL, and LDL/HDL ratio were higher in the VECAD group. Among MCAD group (75.4%) compared to PCAD (58.1%) and VECAD (47.2%) groups, the multi-vessel disease was more common.MCAD patients had the highest median Gensini score compared to PCAD and VECAD patients. Also, in male compared to female the mean Gensini score was higher by 8 units (ß = 8.26, 95%CI = 0.24, 16.28). ConclusionModifiable risk factors in young CAD patients are common. High LDL-C levels and smoking were the common modifiable CVD risk factors in young patients, indicating the significant role of these traditional risk factors in early atherosclerosis development alongside inheritable risk-factors such as positive family history that were more common in young CAD patients. While, the severity of coronary artery involvement in individuals with MCAD was higher, but the priority of involvement based on the type of vessel was almost the same in all CAD groups.

Unveiling the Effects of Diabetes on Coronary Artery Disease Through Angiography

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, particularly among patients with Type 2 Diabetes Mellitus (T2DM). Diabetic patients are at a higher risk of developing CAD due to factors such as poor glycemic control, lipid metabolism abnormalities, and endothelial dysfunction. Prior studies have demonstrated that diabetic patients tend to present with more extensive coronary artery involvement and worse outcomes following cardiovascular interventions. Objective: This study aimed to assess the impact of T2DM on coronary angiography outcomes, specifically focusing on the incidence of multi-vessel disease and the severity of coronary artery stenosis. Methods: This observational cohort study was conducted at Lady Reding Hospital, a tertiary care center specializing in cardiovascular diseases. Participants were recruited from the outpatient cardiology clinic between January 2020 and January 2022. Inclusion criteria included patients aged 40 to 80 years undergoing coronary angiography for the first time due to suspected CAD. Exclusion criteria were previous coronary artery interventions, congenital heart disease, active infections, and renal insufficiency (creatinine &gt; 2.0 mg/dL). Baseline characteristics such as age, gender, BMI, hypertension status, and smoking history were collected. Diabetes status was confirmed via HbA1c levels (≥6.5%). Coronary angiography was performed using standard techniques, with angiograms analyzed by two blinded cardiologists. Primary outcomes included the presence of multi-vessel disease (≥70% stenosis in two or more major coronary arteries) and the severity of stenosis (&gt;70% blockage). Additional assessments using Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) evaluated plaque characteristics and vessel sizes in a subset of patients. Statistical analysis was performed using SPSS version 25.0, employing Chi-square tests for categorical variables, independent t-tests for continuous variables, and multivariable logistic regression to adjust for confounders. Results: The study included 300 participants, with 150 diabetic and 150 non-diabetic patients. Diabetic patients had a mean age of 62.3 ± 10.4 years, while non-diabetic patients had a mean age of 58.2 ± 9.8 years. The prevalence of hypertension was higher among diabetic patients (60%) compared to non-diabetic patients (40%). The incidence of multi-vessel disease was significantly higher in diabetic patients (70%) compared to non-diabetic patients (50%) (p &lt; 0.05). Severe stenosis was observed in 65% of diabetic patients versus 45% of non-diabetic patients (p &lt; 0.01). IVUS and OCT analyses showed a higher prevalence of lipid-rich plaques in diabetic patients (55% vs. 30%) and a smaller mean luminal diameter (2.8 ± 0.6 mm vs. 3.4 ± 0.5 mm). Conclusion: Diabetes significantly impacts the severity and extent of coronary artery disease, with diabetic patients exhibiting higher rates of multi-vessel disease and severe stenosis. Advanced imaging techniques highlighted distinct plaque characteristics in diabetic patients, underscoring the need for aggressive and personalized management strategies. These findings emphasize the importance of integrating advanced imaging and comprehensive management to mitigate cardiovascular risks in diabetic patients.