Management Of Coronary Artery Disease Research Articles

Association of endothelial function and limb artery indices with coronary artery stenosis severity in patients with hypertension

Background Hypertension is one of the major risk factors for cardiovascular events. This study aims to analyse the association of endothelial function and limb artery indices with coronary artery stenosis (CAS) severity in hypertension based on easily accessible and detailed clinical information, and to help accurately identify high-risk groups and avoid missed diagnosis and misdiagnosis. Methods Admission data of 1,375 consecutive hypertensive patients complicated with suspected coronary atherosclerotic heart disease (CHD) from September 2020 to August 2021 in China-Japan Friendship Hospital were retrospectively assessed. All candidates underwent coronary angiography for screening. A total of 600 eligible patients were classified in the CHD group (n = 359) and non-CHD group (n = 241) based on their coronary angiography results. Subjects in the CHD group were further assigned to ‘high stenosis’ (n = 178) and ‘low stenosis’ (n = 181) subgroups based on the median value of Gensini score. Endothelial function and limb artery indicators, including brachial artery flow-mediated vasodilatation (FMD), ankle-brachial index (ABI) and brachial-ankle pulse velocity (baPWV), were examined and compared between subgroups. Multivariate logistic regression analysis and multiple linear regression analysis were carried out to select independent risk factors of CAS severity in hypertension. A predictive equation was conducted according to the results of multivariate logistic regression analysis to make clinical practice easier. As the receiver operating characteristic (ROC) curve had been plotted, the predictive ability of endothelial function and limb artery indicators in CAS severity in hypertension was detected by the area under the curve (AUC). Results In patients with hypertension, the FMD (p = 0.023), ABI (p < 0.001) and baPWV (p < 0.001) of CHD patients appeared substantially different from the non-CHD patients. Furthermore, the ABI (p < 0.001) and baPWV (p = 0.032) both independently associated with CAS severity in hypertensive patients with CHD. Based on the results of multivariate logistic regression analysis with CAS severity as a dependent variable, a predictive equation of baPWV, ABI and FMD was developed: combined coefficient = Logit(p)=5.531–0.218*FMD–7.019*ABI + 0.244*baPWV. From the combined coefficients of baPWV, ABI and FMD, the largest AUC was 0.800, suggesting a powerful predictive value of CAS severity in hypertensive patients, followed by ABI (AUC = 0.747, 95%CI 0.693–0.796), baPWV (AUC = 0.704, 95%CI 0.648–0.756) and FMD (AUC = 0.588, 95%CI 0.529–0.645). Conclusion This study shows that baPWV, ABI and FMD are independent risk factors for CHD, of which, baPWV and ABI are strongly associated with CAS severity in hypertensive patients. The predictive ability of CHD in hypertensive patients may be enhanced through combining the three endothelial function and limb artery indicators. The results may help to facilitate clinical decision-making during treatment and management of coronary artery disease.

Medical Therapy Alone, Percutaneous Coronary Intervention, or Coronary Artery Bypass Grafting for Treatment of Coronary Artery Disease.

In this review, we describe how the management of coronary artery disease (CAD) has become increasingly complex due to the rapid evolution of pharmacotherapy and procedural techniques. The expanding array of treatment options has driven researchers to investigate the optimal combination of therapies; while the findings offer invaluable insights, the sheer volume and occasional contradictions can foster confusion. Given the diverse spectrum of CAD and its manifestations, a tailored treatment decision is critical for each patient. We hope to demonstrate that by integrating the key messages from clinical trials and prioritizing patient comprehension and preference, healthcare providers can guide their patients toward appropriate treatment options, ultimately leading to enhanced care.

The Complementary Role of Cardiopulmonary Exercise Testing in Coronary Artery Disease: From Early Diagnosis to Tailored Management

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, accounting for over 9 million deaths annually. The prevalence of CAD continues to rise, driven by ageing and the increasing prevalence of risk factors such as hypertension, diabetes, and obesity. Current clinical guidelines emphasize the importance of functional tests in the diagnostic pathway, particularly for assessing the presence and severity of ischemia. While recommended tests are valuable, they may not fully capture the complex physiological responses to exercise or provide the necessary detail to tailor personalized treatment plans. Cardiopulmonary exercise testing (CPET) offers a comprehensive assessment of the cardiovascular, pulmonary, and muscular systems under stress, potentially addressing these gaps and providing a more precise understanding of CAD, particularly in settings where traditional diagnostics may be insufficient. By enabling more personalized and precise treatment strategies, CPET could play a central role in the future of CAD management. This narrative review examines the current evidence supporting the use of CPET in CAD diagnosis and management and explores the potential for integrating CPET into existing clinical guidelines, considering its diagnostic and prognostic capabilities, cost-effectiveness, and the challenges associated with its adoption.

Yield of Coronary Assessment in Sustained Monomorphic Ventricular Tachycardia

Coronary assessment is frequently conducted in patients with sustained monomorphic ventricular tachycardia (SMVT); however, its yield and subsequent treatment implications remain unclear. This study aimed to determine the prevalence of coronary artery disease (CAD) in patients presenting with SMVT, factors influencing clinician referral for coronary assessment, and clinical outcomes based on revascularisation or medical management of CAD. Consecutive patients presenting with acute SMVT requiring inpatient admission between 2017 and 2022 were identified. A total of 249 individual patients with SMVT were identified, with 140 undergoing coronary assessment. Referral for coronary assessment was driven by chest pain (p<0.001) and increased troponin kinetics (p<0.001). No patient with SMVT had an acute coronary occlusion. Significant CAD was found in 48 (34%) patients, and traditional ischaemic features did not predict significant CAD. Nineteen (40%) patients with significant CAD underwent revascularisation (n=15 percutaneous coronary intervention, n=4 coronary artery bypass grafting). There was no significant difference in time to ventricular tachycardia (VT) recurrence between revascularised and medically managed CAD (hazard ratio 1.670; 95% confidence interval 0.756-3.687; p=0.199). A total of five of six patients who underwent a revascularisation-only strategy (no upfront antiarrhythmic therapy or ablation) had VT recurrence (median time to recurrence 8.9 months). Despite being frequently performed, coronary assessment in SMVT has only modest yield, with no patients having an acute coronary occlusion. Traditional clinical factors of ischaemia did not improve this yield. Revascularisation alone did not improve freedom from VT.

Prognostic significance of coexistent coronary artery disease in patients undergoing transcatheter aortic valve implantation for aortic stenosis

Abstract Background The optimal management of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) is uncertain. As TAVI expands into lower risk cohorts with longer life expectancies there is increasing need to determine the prognostic significance of coexistent CAD and identify which lesions may benefit from revascularisation. Purpose To evaluate the prognostic significance of coexistent CAD in patients with AS undergoing TAVI stratified according to myocardial territories at risk. Methods Using a retrospective, single-centre, observational registry, patients undergoing TAVI for severe AS between 2015 and 2020 were included. CAD was angiographically determined using computed tomography or invasive coronary angiography. CAD was stratified into 1) low-risk: &amp;lt;70% stenosis in all major epicardial coronary arteries or &amp;lt;50% in the left main (LM); 2) intermediate-risk: ≥70% stenosis in one or two arteries, except the proximal left anterior descending (LAD) and LM; 3) high-risk: ≥70% stenosis in the proximal LAD, ≥70% stenosis in 3 arteries or LM stenosis ≥50%. Patients with previous CABG were categorised as high-risk if: ≥70% stenosis of 3 coronary grafts or graft supplying a proximally stenosed LAD; and intermediate-risk if: ≥70% stenosis of 1 or 2 non-LAD grafts. Baseline characteristics and procedural outcomes were compared between the 3 cohorts, with the impact of CAD on outcomes evaluated after adjustment for demographics and comorbidities. Results 1805 patients were included; median age 84 (79-88), 51% male sex, median logistic Euroscore 13 (8-21). 1281 (71%), 384 (21%) and 140 (8%) patients were characterised as low-, intermediate- and high-risk coronary anatomy respectively. High risk patients were older than the other groups, however, did not have the highest prevalence of comorbidities (Table 1). Other than pacemaker implantation (9% vs 12% vs 6%, p=0.04), there were no differences in procedural complications or in-hospital mortality between groups (Table 1). At a median follow-up of 3.5 (2.3-4.8) years, 920 patients (51%) died, 292 (16%) had hospitalisation for heart failure (HHF) and 565 patients (31%) had a major adverse coronary event (MACE); defined as either myocardial infarction, HHF or cardiovascular death. Coronary anatomical stratification was associated with MACE (Log rank p&amp;lt;0.001) (Figure 1). After multivariate adjustment, high-risk anatomy was associated with all-cause mortality (hazard ratio (HR): 1.34, 95% confidence interval (CI): 1.06-1.68, p=0.013), HHF (HR: 1.49, 95% CI: 1.01-2.21, p=0.046) and MACE (HR: 1.68, 95% CI: 1.27-2.21, p&amp;lt;0.001). Conclusions Whilst the presence of CAD does not impact TAVI procedural safety, untreated high-risk coronary anatomy is associated with future adverse events and may warrant intensive medical therapy and/or revascularisation.

Limited visibility and uptake of the clopidogrel pharmacogenomic guidelines among cardiologists

Abstract Background Clopidogrel is an antiplatelet agent widely utilised in the treatment of acute coronary syndromes and following coronary interventions. Clopidogrel is a prodrug activated in the liver, mostly by cytochrome P450 2C19 that is encoded by a gene (CYP2C19). Variability in CYPC2C19 affects enzymatic activity and leads to variability in the activation and efficacy of clopidogrel. In 2011, the Clinical Pharmacogenetics Implementation Consortium (CPIC) produced the first set of detailed guidelines on the use of genetic testing to guide the clinical utilization of clopidogrel. Updates on these guidelines were published in 2013 and 2022. However, pre-prescription genetic testing is seldom performed. Purpose To establish whether these pharmacogenomics guidelines have visibility within the cardiovascular (CVD)community and have been incorporated into CVD guidelines. Methods (i) We examine the impact of the CPIC Clopidogrel guidelines released in 2013 and 2022 by looking at the citation patterns in CVD journals indexed in PubMed. (ii) We reviewed the guidelines released by the European Society of Cardiology and the American College of Cardiology on the management of coronary interventions and coronary artery disease over the last 15 years to establish whether CPIC guidelines are making any impact on practice. Results The CPIC 2022 guidelines were cited by 88 articles (49 journals) of which 13 citations (14.7%) appear in CVD journals. None of these citations are in the five major journals in which CVD guideline statements are most frequently published (Nature Review Cardiology, European Heart Journal, Circulation, Journal of the American College of Cardiology, and Journal of the American Medical Association - Cardiology). The 2013 guideline received 366 citations (183 PubMed journals). Of these, 47 were in cardiology journals (12.8%), but only 4 citations were in one of the same five major cardiology journals (2 in Nature Review Cardiology, 1 in Circulation and 1 in JAMA Cardiology). Of the 14 guidelines published by the ESC and ACC over the last 14 years, none cited the CPIC clopidogrel guidelines. Only 6 out of the 14 guidelines mentioned that the efficacy of clopidogrel was modulated by genetic factors but none of them included details or practical implications. Conclusion(s) Whilst sufficient time has not yet elapsed for the 2022 CPIC guidelines to have an impact on the specialist literature, the 2013 guidelines have had limited visibility within the CVD community. Undoubtedly, given the potential contribution of PGx, discussions on its uptakes are ongoing thus far, without resolution. Some considerations of clopidogrel genetics are diffusing into the specialty; however, from the citation evidence, it appears that CPIC clopidogrel guidelines of any vintage have had limited impact in terms of adoption and/or endorsement by cardiologists.

Geographical variations and predictors of coronary artery disease mortality in Turkiye: an environmental and behavioral analysis

ObjectiveThis study aims to analyze the geographical variations and identify key environmental and behavioral predictors of coronary artery disease (CAD) mortality in Turkiye.MethodsA 10-year longitudinal province-level data was used to identify change trajectories of CAD mortality. Environmental determinants (such as air quality and climatic conditions) and behavioral factors of alcohol consumption and smoking were examined for their association with CAD mortality change trajectories using Ordinal Logistic Regression models.ResultsThe study revealed significantly different trajectoriesof CAD mortality across Turkiye. Environmental factors, particularly air quality (Particulate Matter-10 variation) and climatic conditions (humidity and temperature variations), were heavily associated with the level of CAD mortality. Behavioral factors, notably alcohol consumption and smoking, also exhibited a significantly positive association. Humidity, sunlight, and temperature remained as key predictors of CAD after controlling for smoking and alcohol consumption.ConclusionThe study underscores the importance of addressing environmental and lifestyle factors in CAD management and prevention strategies. The findings suggest the necessity for region-specific interventions and public health policies tailored to the unique characteristics of each province in Turkiye. This research contributes to a deeper understanding of the multifactorial nature of CAD mortality, providing valuable insights for future research to investigate causal associations, healthcare planning, and policy-making.Trial registrationOur study has been registered in ClinicalTrials.GOV system with a procotol ID of CAD001.

Computed tomography and coronary artery calcium score for screening of coronary artery disease and cardiovascular risk management in asymptomatic individuals.

Several risk prediction models exist to predict atherosclerotic cardiovascular disease in asymptomatic individuals, but systematic reviews have generally found these models to be of limited utility. The coronary artery calcium score (CACS) offers an improvement in risk prediction, yet its role remains contentious. Notably, its negative predictive value has ahigh ability to rule out clinically relevant atherosclerotic cardiovascular disease. Nonetheless, CACS 0does not permanently reclassify to alower cardiovascular risk and periodic reassessment every 5to 10years remains necessary. Conversely, elevated CACS (> 100 or > 75th percentile adjusted for age, sex and ethnicity) can reclassify intermediate-risk individuals to ahigh risk, benefiting from preventive medication. The forthcoming update to the Dutch cardiovascular risk management guideline intends to re-position CACS for cardiovascular risk assessment as such in asymptomatic individuals. Beyond CACS as asingle number, several guidelines recommend coronary CT angiography (CCTA), which provides additional information about luminal stenosis and (high-risk) plaque composition, as the first choice of test in symptomatic patients and high-risk patients. Ongoing randomised studies will have to determine the value of atherosclerosis evaluation with CCTA for primary prevention in asymptomatic individuals.

Evaluating Dyslipidemia and Atherogenic Indices as Predictors of Coronary Artery Disease Risk: A Retrospective Cross-Sectional Study.

The frequency of coronary artery disease (CAD) has alarmingly increased in India accounting for the majority of all fatalities. The primary risk factor for CAD, acute myocardial infarction, and stroke is dyslipidemia. CAD risk can be ascertained by the lipid profile as well as atherogenic risk indices. Due to the current scenario of increased CAD prevalence and the established role of dyslipidemia as a risk factor for CAD, this study aimed at identifying the prevalent lipid abnormalities in a tertiary care hospital in Telangana and studying the predictive value of atherogenic indices for assessing CAD risk. This is a retrospective cross-sectional study. Data pertaining to the subjects from January 2021 to December 2021 was retrieved from the hospital records. Serum triglycerides (TG) were in the higher range for 47 % (n= 235) of total subjects and isolated Low-density lipoprotein (LDL) was higher in 12.6% (n = 63). The overall burden of dyslipidemia was 72.20% (n=361) with 57.6 % (n=208) in males and 42.4% (n=153) in females). The most common dyslipidemia found was Familial Combined Hyperlipidemia in 42.8% (n=214) of individuals. The second most common pattern of dyslipidemia was Primary Familial Hypercholesterolemia which was observed in 25% (n=125) of subjects. Dysbetalipoproteinemia was seen in 24.2% (n=121) of the study subjects. ROC analysis found the Atherogenic Coefficient (AC) to be the most sensitive and specific cardiovascular risk index. 57.8% of the subjects had AC >2.44 and were at the highest risk for developing CAD. The overall burden of dyslipidemia was 72.2%. AC was found to be the most sensitive and specific cardiovascular risk index by ROC curve analysis. Around 57.8% of the subjects had AC >2.44 and were at the highest risk for developing CAD. This study emphasizes the importance of atherogenic indices in the primary prevention and management of CAD, a growing non-communicable disease.

The role of advanced physiological guidance in contemporary coronary artery disease management.

This review evaluates the emerging role of the pullback pressure gradient (PPG) as a standardized metric for assessing coronary artery disease (CAD) patterns and its implications for clinical decision-making when managing patients undergoing percutaneous coronary interventions (PCIs). By integrating PPG with existing physiological assessments, this review highlights the potential benefits of PPG in predicting treatment outcomes and refining therapeutic strategies for CAD. Recent studies, particularly the PPG Global study have demonstrated a strong correlation between PPG values and post-PCI outcomes, revealing that focal disease is associated with improved fractional flow reserve (FFR) and lower rates of adverse events than vessels with diffuse disease (low PPG). Additionally, PPG has been linked to specific atherosclerotic plaque characteristics, indicating its utility in identifying high-risk plaques. The integration of PPG with advanced imaging techniques further enhances the understanding of CAD patterns and their implications for treatment planning. The PPG represents a significant advancement in the management of CAD, providing a reproducible and objective assessment of coronary artery disease patterns that can inform clinical decision-making. As research continues to explore the relationship among PPG, atherosclerotic characteristics, and patient outcomes, its integration into routine practice is expected to improve the effectiveness of PCI and optimize patient management strategies. Future studies are warranted to establish specific PPG thresholds and further investigate its potential in identifying vulnerable plaques and guiding treatment decisions.

Role of lymphocyte-to-monocyte ratio as a predictive marker for diabetic coronary artery disease: A cross-sectional study.

The lymphocyte to monocyte ratio (LMR) is considered a marker of systemic inflammation in cardiovascular disease and acts as predictor of mortality in coronary artery disease. To investigate the predictive role of LMR in diabetic coronary artery disease patients. This cross-sectional study was conducted at tertiary care super-specialty hospital at New Delhi, India. A total of 200 angiography-proven coronary artery disease (CAD) patients were enrolled and grouped into two categories: Group I [CAD patients with type 2 diabetes mellitus (T2DM) and glycated hemoglobin (HbA1c) levels ≥ 6.5%], and Group II (CAD patients without T2DM and HbA1c levels < 6.5%). Serum lipoproteins, HbA1c, and complete blood count of enrolled patients were analyzed using fully automatic analyzers. The logistic regression analysis showed an odds ratio of 1.48 (95%CI: 1.28-1.72, P < 0.05) for diabetic coronary artery disease patients (Group I) in unadjusted model. After adjusting for age, gender, diet, smoking, and hypertension history, the odds ratio increased to 1.49 (95%CI: 1.29-1.74, P < 0.01) in close association with LMR. Further adjustment for high cholesterol and triglycerides yielded the same odds ratio of 1.49 (95%CI: 1.27-1.75, P < 0.01). Receiver operating characteristic curve analysis revealed 74% sensitivity, 64% specificity, and 0.74 area under the curve (95%CI: 0.67-0.80, P < 0.001), suggesting moderate predictive accuracy for diabetic CAD patients. LMR showed positive association with diabetic coronary artery disease, with moderate predictive accuracy. These findings have implications for improving CAD management in diabetics, necessitating further research and targeted interventions.

Comparative Analysis of T2 and T1 MRI for Coronary Artery Disease Detection

Coronary artery disease (CAD) remains a significant contributor to global mortality. Non-invasive imaging modalities are indispensable for the diagnosis and management of CAD. Magnetic Resonance Imaging (MRI) has emerged as a promising tool due to its inherent lack of ionizing radiation and its capacity to provide detailed anatomical and functional insights. This article presents a comprehensive review of the current literature, comparing the utilization of T2 and T1 MRI techniques in CAD detection. We highlight the advantages, limitations, and specific clinical applications of each modality. T1 MRI with contrast enhancement excels in visualizing coronary artery walls and plaques, assessing myocardial perfusion, and detecting scarring. In contrast, T2 MRI, without the need for contrast agents, is invaluable for detecting myocardial edema, a key indicator in the diagnosis of acute myocardial infarction. The selection between T2 and T1 MRI should be judiciously based on the specific clinical question and patient considerations.

Whole Food Plant-Based Dietary Education for Frontline RNs

Background: Coronary artery disease (CAD) is the leading cause of death for men and women in the United States, with myocardial infarction (MI) being a serious outcome. Plant-based diets are associated with a reduced incidence of CAD. Registered nurses (RNs) are highly trusted members of the healthcare team and are ethically responsible for providing reliable information based on scientific sources and guideline-directed recommendations. Registered nurses are optimally positioned to provide education on adopting whole foods plant-based (WFPB) diets to patients experiencing CAD inside and outside the hospital setting. It is unknown the degree to which nurses have adopted WFPB eating patterns and incorporated WFPB patient education into routine nursing care. The purpose of this study is to describe RN perceptions (susceptibility, severity, benefits and barriers, self-efficacy) related to the effect of a WFPB meal pattern for prevention and management of CAD, and RN intention to apply this dietary knowledge to their own health behaviors and nursing practices. Methods: This descriptive quasi-experimental pretest-posttest study measured concepts from the health belief model including RN perceptions of susceptibility, severity, benefits, and barriers, as well as self-efficacy and meal behaviors. The participating RNs completed these measures before and after they participated in any of the educational interventions designed using experiential learning theory. Registered nurses had the option of attending one or all three educational interventions on WFPB nutrition and CAD. Results: Eighty-six RNs working in cardiology specialties on three inpatient or one outpatient cardiac units at a large southeastern hospital system participated. The nurses believed CAD is a serious diagnosis (72/72) and that WFPB dietary patterns are cardioprotective for the prevention and management of CAD (63/72). However, nurse dietary behaviors were incongruent with their beliefs as some RNs (14/72) indicated they did not consume any vegetarian or fully plant-based meals. The most common barrier (36/72) to nurses adopting a WFPB dietary pattern was a taste preference for meat and animal products. Half of the eight nurses who completed at least one of the educational interventions and the postsurvey reported increased confidence to advise patients with CAD on the WFPB dietary pattern. Combined, participants self-reported their vegetarian or fully plant-based meal frequency increased slightly. Discussion: Registered nurses lack a working knowledge of WFPB eating patterns in their personal and professional lives, which may impact the quality of dietary education they provide to people with CAD or MI. Overcoming barriers to education on WFPB dietary patterns is important for increasing nurse confidence in teaching people with CAD about this evidence-based dietary health behavior. Conclusion: Registered nurses’ knowledge and perceptions of WFPB eating patterns may be enhanced through professional development activities. RNs may be more likely to engage with education that is frequent, brief, asynchronous, and online or part of existing onboarding such as lunch and learn events to sample WFPB foods. Future research is needed on strategies to engage and empower RNs to educate people with CAD on WFPB nutrition.

Long-term efficacy of drug-coated balloon-only angioplasty for IgG4-related coronary artery disease: A case report

Abstract Background Although coronary artery involvement in patients with IgG4-related disease (IgG4-RD) is rare, emergency revascularisation is recommended for managing acute coronary syndrome. However, coronary aneurysm formation and stent migration after sirolimus-eluting stent implantation have been reported for this disease. Thus, new treatment modalities are warranted for the management of coronary artery disease in this vasculitis. Case summary A 70-year-old male who experienced progressive chest discomfort for 1 month underwent cardiac examination. Coronary computed tomography angiography (CCTA) revealed right coronary artery hypoplasia, coronary artery aneurysm with severely calcified stenosis in the proximal left anterior descending artery (LAD), and subtotal obstruction in the mid-LAD. The left circumflex artery (LCX) also had stenosis and dilated lesions. Additionally, diffuse perivascular soft tissue thickening was observed in the mid-LCX. Percutaneous coronary intervention was performed for the proximal- and mid-LAD lesions. Rotational atherectomy with low-pressure drug-coated balloon (DCB) dilation was considered for these lesions owing to suspicion of vasculitis. The patient was later diagnosed with Sjögren's syndrome and IgG4-RD overlap syndrome. Oral steroids and immunosuppressive drugs were initiated. In a follow-up at 7 and 26 months, late lumen enlargement was observed in the treated area of the LAD, without enlargement of the adjacent aneurysm. CCTA performed after 26 months revealed resolution of the diffuse perivascular soft tissue thickening in the mid-LCX. Discussion To our knowledge, this is the first case report demonstrating favourable outcomes for treatment of a coronary artery lesion attributed to IgG4-RD with DCB, leaving nothing implanted in the coronary artery tree.

Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease.

Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.

Pharmaceutical Care in Chronic Coronary Artery Disease Management

Individuals who suffer from Acute Coronary Artery Disease (CAD) frequently experience related issues, either because of the illness itself or as a side effect. Despite the existence of established criteria, Drug-Related Problems (DRPs) are more likely to arise, which impairs therapy outcomes and overburden patients. The purpose of this study is to assess clinical pharmacist-initiated medication optimisation in ACS patients. In order to optimise pharmacotherapy and the patient care process, a comprehensive clinical pharmacy service was created and deployed for the management of acute coronary syndrome (ACS-CPS). The service activities were prototyped under four primary themes. Our research showed the proactive role of clinical chemists in starting and offering services such as transition care, medication reconciliation, medication optimisation, and evidence-based drug information and interventions

Polygenic Risk Scores: The Next Step for Improved Risk Stratification in Coronary Artery Disease?

Despite significant advances in the management of coronary artery disease (CAD) and reductions in annual mortality rates in recent decades, this disease remains the leading cause of death worldwide. Consequently, there is an ongoing need for efforts to address this situation. Current clinical algorithms to identify at-risk patients are particularly inaccurate in moderate-risk individuals. For this reason, the need for ancillary tests has been suggested, including predictive genetic screening. As genetic studies rapidly expand and genomic data becomes more accessible, numerous genetic risk scores have been proposed to identify and evaluate an individual's susceptibility to developing diseases, including CAD. The field of genetics has indeed made substantial contributions to risk prediction, particularly in cases where children have parents with premature CAD, resulting in an increased risk of up to 75%. The polygenic risk scores (PRSs) have emerged as a potentially valuable tool for understanding and stratifying an individual's genetic risk. The PRS is calculated as a weighted sum of single-nucleotide variants present throughout the human genome, identifiable through genome-wide association studies, and associated with various cardiometabolic diseases. The use of PRSs holds promise, as it enables the development of personalized strategies for preventing or diagnosing specific pathologies early. Furthermore, it can complement existing clinical scores, increasing the accuracy of individual risk prediction. Consequently, the application of PRSs has the potential to impact the costs and adverse outcomes associated with CAD positively. This narrative review provides an overview of the role of PRSs in the context of CAD.

Clinical outcomes of different revascularization approaches for patients with multi-vessel coronary artery disease: A network meta-analysis.

As surgical techniques continue to evolve, the optimal approach for revascularizing multi-vessel coronary artery disease (CAD) remains a matter of ongoing debate. Accordingly, our objective was to compare and contrast various surgical techniques utilized in the management of multi-vessel CAD. A systematic literature review was performed using PubMed, Embase, and Cochrane central register of controlled trials from inception to May 2022. Random-effects network meta-analysis was performed for the primary outcome; target vessel revascularization (TVR), and secondary outcomes; mortality, major adverse cardiac and cerebrovascular events, postoperative myocardial infarction, new-onset atrial fibrillation, stroke, new-onset dialysis, in patients undergoing percutaneous coronary intervention (PCI) with a stent, off-pump coronary bypass graft, on-pump coronary artery bypass graft (ONCABG), hybrid coronary revascularization, minimally-invasive coronary artery bypass, or robot-assisted coronary artery bypass (RCAB) surgeries. A total of 8841 patients were included from 23 studies. The analysis showed that ONCABG had the highest freedom from TVR, with a mean (SD) absolute risk of 0.027 (0.029); although ONCABG was found to be superior to all other methods, it was only significantly better than first-generation stent PCI. While RCAB did not demonstrate significant superiority over other treatments, it showed a greater probability of preventing postoperative complications. Notably, no significant heterogeneity was calculated for any of the reported outcomes. ONCABG shows a better rank probability compared to all other techniques for preventing TVR, while RCAB offers greater freedom from most postoperative complications. However, given the absence of randomized controlled trials, these results should be interpreted with caution.

The Spectrum of Coronary Artery Disease in Elite Endurance Athletes-A Long-Standing Debate: State-of-the-Art Review.

Physical activity is recommended for the prevention of primary and secondary cardiovascular (CV) disease as it is linked to a number of health benefits, especially CV. However, recent research suggests that high-volume, long-term endurance exercise may hasten rather than slow the coronary atherosclerosis progression. This contentious theory has generated a great discussion and is still a major source of doubt when it comes to the clinical treatment of coronary artery disease (CAD) in athletes. CAD is the primary cause of sudden cardiac death in athletes over 35 years. Thus, recent studies evaluated the prevalence of CAD in athletes and its clinical and prognostic implications. Indeed, many studies have shown a relationship between endurance sports and higher volumes of coronary calcified plaque as determined by computed tomography. However, the precise pathogenetic substrate for the existence of an increased coronary calcification burden among endurance athletes remains unclear. Moreover, the idea that coronary plaques in elite athletes present a benign morphology has been cast into doubt by some recent studies showing potential association with adverse cardiovascular events. This review aims to analyze the association between physical activity and CAD, explaining possible underlying mechanisms of atherosclerotic progression and non-ischemic coronary lesions, focusing primarily on clinical and prognostic implications, multimodal evaluation, and management of CAD in endurance athletes.

APPROACH e-PROM system: a user-centered development and evaluation of an electronic patient-reported outcomes measurement system for management of coronary artery disease

BackgroundCoronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system. This e-PROM system is an electronic system for the administration of PROMs to patients with CAD and the delivery of the summarized information to their care providers to facilitate patient-physician communication and shared decision-making. This electronic platform was designed to be accessible via web-based and hand-held devices. Heuristic and user acceptance evaluation were conducted with patients and attending care providers.ResultsThe APPROACH e-PROM system was co-developed with patients and care providers, research investigators, informaticians and information technology experts. Five PROMs were selected for inclusion in the online platform after consultations with patient partners, care providers, and PROMs experts: the Seattle Angina Questionnaire, Patient Health Questionnaire, EuroQOL, and Medical Outcomes Study Social Support Survey, and Self-Care of Coronary Heart Disease Inventory. The heuristic evaluation was completed by four design experts who examined the usability of the prototype interfaces. User acceptance testing was completed with 13 patients and 10 cardiologists who evaluated prototype user interfaces of the e-PROM system.ConclusionBoth patients and physicians found the APPROACH e-PROM system to be easy to use, understandable, and acceptable. The APPROACH e-PROM system provides a user-informed electronic platform designed to incorporate PROMs into the delivery of individualized cardiac care for persons with CAD.