Nature Of Atherosclerosis Research Articles

Use of cutting or scoring balloons in patients with native coronary artery disease: systematic review and meta-analysis

Use of cutting or scoring balloons in patients with native coronary artery disease: systematic review and meta-analysis

Treatment of coronary lesions with a novel crystalline sirolimus-coated balloon.

There is mounting data supporting the use of drug-coated balloons (DCB) not only for treatment of in-stent restenosis (ISR), but also in native coronary artery disease. So far, paclitaxel-coated balloons represented the mainstay DCBs. The SeQuent® crystalline sirolimus-coated balloon (SCB) (B.Braun Medical Inc, Germany) represents a novel DCB, which allows a sustained release of the limus-drug. We evaluated its performance in an all-comer cohort, including complex coronary lesions. Consecutive patients treated with the SeQuent® SCB were analyzed from the prospective SIROOP registry (NCT04988685). We assessed clinical outcomes, including major adverse cardiovascular events (MACE), target lesion revascularization (TLR), target vessel myocardial infarction (TV-MI) and cardiovascular death. Angiograms and outcomes were independently adjudicated. From March 2021 to March 2023, we enrolled 126 patients and lesions, of which 100 (79%) treated using a "DCB-only" strategy and 26 (21%) with a hybrid approach (DES + DCB). The mean age was 68 ± 10 years, 48 (38%) patients had an acute coronary syndrome. Regarding lesion characteristics, ISR was treated in 27 (21%), 11 (9%) underwent CTO-PCI and 59 (47%) of the vessels were moderate to severe calcified. Procedural success rate was 100%. At a median follow-up time of 12.7 (IQR 12; 14.2) months, MACE occurred in 5 patients (4.3%). No acute vessel closure was observed. Our data indicates promising outcomes following treatment with this novel crystalline SCB in an all-comer cohort with complex coronary lesions. These results require further investigation with randomized trials.

Identifying Risk Factors for Native Coronary Atherosclerosis Progression After Percutaneous Coronary Intervention

Identifying Risk Factors for Native Coronary Atherosclerosis Progression After Percutaneous Coronary Intervention

Sex Differences in Coronary Artery Disease Characteristics Among Patients With Type 2 Myocardial Infarction

BackgroundType 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this population. ObjectivesThe purpose of this study was to evaluate sex-based disease differences in type 2 MI among patients evaluated with coronary computed tomography angiography and fractional flow reserve. MethodsIn a single-center, prospective study, patients with strictly adjudicated type 2 MI underwent coronary computed tomography angiography with fractional flow reserve. ResultsAmong 50 study participants enrolled, 50% were women. A similar mix of MI precipitants was present in both sexes. ST-segment depression was more common in women (64% vs 32%), while men were more likely to have T wave inversion (68% vs 36%). Women and men had comparable coronary artery calcium scores (median: 152 [Q1, Q3: 45, 762] vs 234 [Q1, Q3: 56, 422]). Prevalence of any CAD (84% vs 100%), obstructive CAD (24% vs 28%), and hemodynamically significant focal stenosis (20% vs 32%) were similar between sexes. Total plaque volume was similar between sexes, but women had significantly lower levels of low-attenuation plaque (median: 3 [Q1, Q3: 1, 7] vs 9 [Q1, Q3: 3, 14]). ConclusionsAmong patients with type 2 MI, prevalence of any CAD and obstructive CAD did not differ according to sex. Total plaque volume was similar between sexes, but women had a lower volume of low-attenuation plaque (DEFINing the PrEvalence and Characteristics of Coronary Artery Disease Among Patients With TYPE 2 Myocardial Infarction Using CT-FFR [DEFINE TYPE2MI]; NCT04864119)

Naturally Occurring Atherosclerosis Progression and In-stent Restenosis: Exploring Histomorphologic Associations Using Optical Coherence Tomography.

The mechanism of in-stent restenosis (ISR) remains elusive, and in-stent neoatherosclerosis (ISNA) may hold significant pathophysiologic implications. Nevertheless, the correlation between ISNA and the progression of untreated coronary segments affected by native atherosclerosis remains incompletely investigated. This study enrolled 225 patients diagnosed with coronary heart disease and multivessel disease. These patients underwent successful percutaneous coronary intervention and intraoperative placement of the drug-eluting stent, followed by optical coherence tomography assessment of the culprit stent. The mechanism of ISR was examined through qualitative and quantitative analysis of optical coherence tomography imaging. A significantly higher proportion of patients in the ISR with nontarget lesion progression (N-TLP) group exhibited lipid plaque formation compared with the ISR without N-TLP group (69.0% vs. 39.8%, P < 0.001). The incidence of thin-cap fibroatheroma (33.3% vs. 11.4%, P = 0.001) and ISNA (60.7% vs. 38.6%, P < 0.001) was markedly elevated in the ISR with N-TLP group compared with the ISR without N-TLP group. Regarding manifestations, heterogeneous hyperplasia was predominantly observed in the ISR with N-TLP group (76.2% vs. 38.6%, P < 0.001), whereas homogeneous hyperplasia was primarily presented in the ISR without N-TLP group (61.4% vs. 23.8%, P < 0.001). Patients displaying notable progression of naturally occurring atherosclerosis manifest histomorphologic features of ISR, primarily characterized by heterogeneous intimal hyperplasia and a higher prevalence of ISNA. In contrast, patients without substantial progression of naturally occurring atherosclerosis exhibit histomorphologic features of ISR primarily characterized by homogeneous intimal hyperplasia.

Coronary angiography and intervention after transcatheter aortic valve implantation (TAVI): the nationwide SWEDEHEART registry

Abstract Background Coronary access after transcatheter aortic valve implantation (TAVI) can be challenging and complicate percutaneous coronary intervention (PCI). Therefore, pre-existing severe coronary stenosis is usually treated either before or during the TAVI procedure. However, due to the progressive nature of coronary artery disease (CAD), some patients require urgent or elective coronary angiography and intervention after their TAVI procedure. Purpose To assess the indication, the incidence, and feasibility of coronary angiography and intervention after TAVI. Methods All patients undergoing TAVI between 2008 and 2021 from the Swedish Transcatheter Cardiac Intervention Registry (SWENTRY) were included. SWENTRY was further linked to the Swedish Coronar Angiography and Angioplasty Registry (SCAAR) and the National Cause of Death Registry. Results Among 8819 patients undergoing TAVI, 697 angiograms were performed in 515 patients (5.8%) after TAVI (43.1 % after balloon-expandable bioprosthesis, 49.5 % after self-expandable bioprosthesis) at a median follow up of 841 days (interquartile range: 346 to 1457 days). PCI was performed in 347 patients (49.8%) with a success rate of 92.5% with no significant differences between patients implanted with balloon-expandable and self-expandable bioprostheses (93.0% vs.91.5%; p=0.62). The most common indications for PCI after TAVI were non-ST elevation acute coronary syndrome (NSTE-ACS) (45.8%), chronic coronary syndrome (30.3%), ST elevation myocardial infarction (6.9%) and congestive heart failure (3.5%). The cumulative incidence of angiograms with or without PCI at 30 days, 1 year, 2 years and 5 years were 6.9, 37.2, 60.2 and 90.2 percent of the total number of angiograms respectively (Figure). Conclusion Coronary angiogram and interventions after TAVI are rare, with an incidence declining over time after TAVI. The main indication for coronary angiogram and PCI was NSTE-ACS. PCIs were successfully performed after TAVI, with no apparent differences between balloon-expandable and self-expandable bioprostheses.

Abstract 11776: Sex Differences in Coronary Artery Disease Characteristics Among Patients With Type 2 Myocardial Infarction: Results From the Prospective DEFINE-Type 2 MI Study

Background: Type 2 Myocardial Infarction (T2MI) is a result of coronary supply and demand imbalance and is associated with a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this specific population. Retrospective analyses are limited by selection bias, unequal proportions of male and female subjects, and lack of angiographic definition. Hypothesis: In patients with T2MI, women and men will have unique characteristics. Aim: To evaluate sex-based differences in presentation, prevalence/characteristics of CAD and clinical management of T2MI. Methods: In a single-center prospective study, patients with strictly adjudicated T2MI underwent coronary computed tomography angiography and Fractional Flow Reserve (FFR CT ) and quantitative plaque assessment was performed. Results: Of 50 study participants enrolled, 50% were women. Women with T2MI were older than men with T2MI (72.2 ± 10.1 vs. 64 ± 11.3 years; p = 0.009) but otherwise had similar baseline characteristics. A broad and similar mix of T2MI precipitants were present among both sexes. Ischemic ST depression was more common in women (64% vs. 32%; p = 0.05) while men were more likely to have T wave inversion (68% vs. 36%; p = 0.05). Women and men had comparable CAC scores (median [Q1, Q3] 152 [45, 762] vs. 234 [56, 422]; p = 0.07). Prevalence of any CAD (100% vs. 84%; p = 0.12), obstructive CAD (28% vs. 24%; p = 1.0), and hemodynamically significant focal stenosis with FFR CT &lt; 0.80 (64% vs. 56%; p = 0.08) were similar between men and women. While total plaque volumes were similar between men and women, women had significantly lower levels of low-attenuation plaque (median [Q1, Q3]: 3 [1,7] vs. 9 [3, 14]; p = 0.03). Men and women did not significantly differ in percentile of plaque burden. Both sexes showed comparable increases in the utilization of aspirin (OR = 0.67; p = 0.53), beta blockers (OR = 0.76; p = 0.71), and statins (OR = 0.22; p = 0.08) by discharge. Conclusions: This prospective study of using FFRCT in T2MI identifies similarities and differences in clinical presentation and CAD characteristics of T2MI in both men and women. These findings may be helpful in improving the identification and management of T2MI.

Abstract 15381: Clinical Outcomes of Post-Drug-Coated Balloon Angioplasty Dissection in Large De-Novo Coronary Artery Disease

Introduction: Drug-coated balloon (DCB) may be an alternative to stents in the treatment of large native coronary artery disease. However, the complications of acute elastic recoil and coronary dissections confine the practical application of DCB. Little is known about the clinical outcomes of different types of dissection after DCB angioplasty with or without stenting. Aims: This study sought to investigate the clinical outcomes of post-DCB dissection in large de novo coronary artery disease. Methods: This was a retrospective observational study. A consecutive series of patients with large native coronary artery disease (reference diameter ≥ 3.0 mm) who occurred coronary dissections after the treatment of DCB angioplasty were included. These patients were divided into stented groups and non-stented groups depending on whether bail-out stents were employed. Post-angioplasty coronary artery dissections were classified into type A-F. The cumulative incidence of major adverse cardiac events (MACE) was compared between the two groups. Results: Between March 2017 and October 2022, 676 patients with large de novo coronary artery disease developed post-DCB angioplasty dissection, 554 of which treated with DCB only, 122 of which underwent bail-out stent implantation. These dissections were type A (60.5%), B (30.9%), C (6.5%), D (1.9%) and F (0.1%), respectively. During a mean follow-up of 1 year, MACE occurred in 60 patients (9 in the stented group and 51 in the non-stented group; 7.4% vs. 9.2%; p=0.522). For type B dissection, the rate of MACE was similar in the stented group than that in the non-stented group (11.1% vs. 8.2%; p=0.502). For type C dissection, the rate of MACE was numerically higher in the non-stented group than that in the stented group (9.5% vs. 0%; p=0.222). Conclusions: For post-DCB angioplasty dissection in large de-novo coronary artery disease, type B dissection requires no bail-out stent implantation and type C dissection deserves further investigation.

Transplant Vasculopathy Versus Native Atherosclerosis: Similarities and Differences.

Cardiac allograft vasculopathy (CAV) is one of the leading causes of graft failure and death after heart transplantation. Alloimmune-dependent and -independent factors trigger the pathogenesis of CAV through activation of the recipients' (and to a lesser extent donor-derived) immune system. Early diagnosis of CAV is complicated by the lack of clinical symptoms for ischemia in the denervated heart, by the impact of early functional coronary alterations, by the insensitivity of coronary angiography, and by the involvement of small intramyocardial vessels. CAV in general is a panarterial disease confined to the allograft and characterized by diffuse concentric longitudinal intimal hyperplasia in the epicardial coronary arteries and concentric medial disease in the microvasculature. Plaque composition in CAV may include early fibrous and fibrofatty tissue and late atheromatous calcification. In contrast, native coronary atherosclerosis usually develops over decades, is focal, noncircumferential, and typically diminishes proximal parts of the epicardial vessels. The rapid and early development of CAV has an adverse prognostic impact, and current prevention and treatment strategies are of limited efficacy compared with established strategies in native atherosclerosis. Following acute coronary syndromes, patients after heart transplantation were more likely to have accompanying cardiogenic shock and higher mortality compared with acute coronary syndromes patients with native hearts.

TCT-529 Potent Antiplatelet Inhibition Using Ticagrelor Compared to Clopidogrel in Patients Undergoing Drug-Coated Balloon Angioplasty for De Novo Native Coronary Artery Disease

TCT-529 Potent Antiplatelet Inhibition Using Ticagrelor Compared to Clopidogrel in Patients Undergoing Drug-Coated Balloon Angioplasty for De Novo Native Coronary Artery Disease

Sex-specific inequalities in the use of drug-coated balloons for small coronary artery disease: a report from the BASKET-SMALL 2 trial

Background and objectivesRecent data have established non-inferiority of drug-coated balloons (DCB) compared to drug-eluting stents (DES) for treatment of small-vessel coronary artery disease. Since coronary vessels in women might have anatomical and pathophysiological particularities, the safety of the DCB strategy among women compared to men needs to be assessed in more detail.MethodsIn BASKET-SMALL 2, patients with de novo lesions in coronary vessels < 3 mm and an indication for percutaneous coronary intervention were randomly allocated (1:1) to DCB vs. DES after successful lesion preparation. The primary objective of the randomized trial was to establish non-inferiority of DCB vs. DES regarding major adverse cardiac events (MACE; i.e., cardiac death, non-fatal myocardial infarction, and target vessel revascularization) after 12 months. The aim of the current sub-analysis is to evaluate whether the DCB strategy is equally safe among women and men after 12 and 36 months.ResultsAmong 758 randomized patients, 382 were assigned to DCB (23% women) and 376 to DES (30% women). In general, women were older, had more often diabetes mellitus and renal insufficiency, and presented more often with an acute coronary syndrome, whereas men were more often smokers, had multivessel disease and a previous history of acute myocardial infarction, and received a treatment with a statin. After 3 years, the primary clinical end point was not significantly different between groups (13% women vs. 16% men, HR 0.82; 95% CI 0.52−1.30; p = 0.40). There was no interaction between sex and coronary intervention strategy regarding MACE at 36 months (10% women vs. 16% men in DCB, 16% women vs. 15% men in DES; pinteraction = 0.31).ConclusionIn small native coronary artery disease, there was no statistically significant effect of sex on the difference between DCB and DES regarding MACE up to 36 months.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01574534.Graphical abstractCAD coronary artery disease, MACE major adverse cardiovascular events, HR Hazard ratio, DCB drug-coated balloon, DES drug-eluting stent

Therapeutic Strategies and Future Directions of Management for Patients with a History of Coronary Artery Bypass Grafting Who Require Secondary Coronary Revascularization

Secondary coronary revascularizations can be required due to the progression of coronary artery lesions and degeneration of bypass grafts in the long term after initial coronary artery bypass graft (CABG) surgery. It is therefore necessary to clarify the clinical characteristics of these patients and how to improve their prognosis. Optimal medical treatments, including medications, smoking cessation, and cardiac rehabilitation, are essential baseline management to prevent the progression of native coronary atherosclerosis and degradation of bypass grafts among all post-CABG patients who undergo secondary coronary revascularization as well as those who undergo initial CABG surgery in order to avoid situations requiring secondary coronary revascularization. All coronary revascularization procedures should be built upon these firm optimal medical treatments. Percutaneous coronary intervention is the current mainstay of secondary coronary revascularization approaches for patients who have symptoms of heart failure or angina pectoris because of the low invasiveness of the technique and no need for re-sternotomy. Redo-CABG is an option, especially for young patients without patency for internal thoracic artery to left anterior descending artery graft. The individualization of these approaches and improvements in medications and coronary revascularization procedures may improve the clinical outcomes and prognosis of this subgroup.

Impact of myocardial bridging on coronary artery plaque formation and long-term mortality after heart transplantation

ObjectivesThis study aimed to explore the impact of myocardial bridging (MB) on early development of cardiac allograft vasculopathy and long-term graft survival after heart transplantation. BackgroundMB has been reported to be associated with acceleration of proximal plaque development and endothelial dysfunction in native coronary atherosclerosis. However, its clinical significance in heart transplantation remains unclear. MethodsIn 103 heart-transplant recipients, serial (baseline and 1-year post-transplant) volumetric intravascular ultrasound (IVUS) analyses were performed in the first 50 mm of the left anterior descending (LAD) artery. Standard IVUS indices were evaluated in 3 equally divided LAD segments (proximal, middle, and distal segments). MB was defined by IVUS as an echolucent muscular band lying on top of the artery. The primary endpoint was death or re-transplantation, assessed for up to 12.2 years (median follow-up: 4.7 years). ResultsIVUS identified MB in 62% of the study population. At baseline, MB patients had smaller intimal volume in the distal LAD than non-MB patients (p = 0.002). During the first year, vessel volume decreased diffusely irrespective of the presence of MB. Intimal growth diffusely distributed in non-MB patients, whereas MB patients demonstrated significantly augmented intimal formation in the proximal LAD. Kaplan-Meier analysis revealed significantly lower event-free survival in patients with versus without MB (log-rank p = 0.02). In multivariate analysis, the presence of MB was independently associated with late adverse events [hazard ratio 5.1 (1.6–22.2)]. ConclusionMB appears to relate to accelerated proximal intimal growth and reduced long-term survival in heart-transplant recipients.

Serial quantitative angiographic study of target lumen enlargement after drug-coated balloon angioplasty for native coronary artery disease.

Target lumen enlargement (TLE) or "late lumen enlargement" is often encountered after percutaneous coronary intervention (PCI) with drug-coated balloons (DCB). To date, the prognosis of coronary arterial lesions with or without TLE has not been clearly elucidated. This study aimed to assess the long-term prognosis of coronary arterial lesions with or without TLE observed within 1 year (early TLE) after DCB angioplasty using serial quantitative angiographic follow-up. One hundred and ninety-three consecutive patients (de novo coronary arterial lesions, 251) who underwent follow-up angiography within 1 year after DCB angioplasty (early follow-up, median: 6 months) were retrospectively evaluated. Of these, 97 patients (125 lesions) also underwent angiography more than 1 year after DCB angioplasty (late follow-up, median: 37 months). TLE was defined as an increase in minimal lumen diameter (MLD) after PCI at each follow-up. Early TLE was detected in 142 lesions (56.6%). Of these, 76 lesions were also evaluated at late follow-up. TLE persisted even at late follow-up in 67 of the 76 lesions (88.2%). An increase in MLD in early TLE (+) lesions was observed in the period between post-PCI and early follow-up (1.84 ± 0.06 vs. 2.12 ± 0.07 mm, p < 0.001) but not between early and late follow-up (2.12 ± 0.07 vs. 2.16 ± 0.07 mm, p = 0.74). In contrast, 49 of 109 lesions without early TLE were evaluated at late follow-up, of which 28 lesions (57.1%) showed TLE at late follow-up. The MLD of early TLE (-) lesions (n = 49) significantly increased from early (1.63 ± 0.061 mm) to late follow-up (1.84 ± 0.06 mm) (p < 0.001). No aneurysms were found in any of these cases. Early TLE was observed in more than half of the lesions, with the majority remaining at late follow-up. Alternatively, half of the lesions without early TLE showed late TLE, occurring biphasically after DCB angioplasty.

Causes of Hospitalization among End-Stage Kidney Disease Cohort before and after Hemodialysis.

Patients with end-stage kidney disease (ESKD) have a greater risk of comorbidities, including diabetes and anemia, and have higher hospital admission rates than patients with other diseases. The cause of hospital admissions is associated with ESKD prognosis. This retrospective cohort study involved patients with ESKD who received hemodialysis and investigated whether the cause of hospital admission changed before versus after they started hemodialysis. This study recruited 592 patients with ESKD who received hemodialysis at any period between January 2005 and November 2017 and had been assigned the International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) code for ESKD. The patients’ demographic data and hospitalization status one year before and two years after they received hemodialysis were analyzed. A McNemar test was conducted to analyze the diagnostic changes from before to after hemodialysis in patients with ESKD. The study’s sample of patients with ESKD comprised more women (51.86%) than men and had an average age of 67.15 years. The numbers of patients admitted to the hospital for the following conditions all decreased significantly after they received hemodialysis: type 2 (non-insulin-dependent and adult-onset) diabetes; native atherosclerosis; urinary tract infection; gastric ulcer without mention of hemorrhage, perforation, or obstruction; pneumonia; reflux esophagitis; duodenal ulcer without mention of hemorrhage, perforation, or obstruction; and bacteremia. Most patients exhibited one or more of the following comorbidities: diabetes (n = 407, 68.75%), hypertension (n = 491, 82.94%), congestive heart failure (n = 161, 27.20%), ischemic heart disease (n = 125, 21.11%), cerebrovascular accident (n = 93, 15.71%), and gout (n = 96, 16.22%). An analysis of variance (ANOVA) indicated that changes in the ICD-9-CM codes for native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were associated with age. Patients who developed pneumonia before or after they received hemodialysis tended to be older (range: 69–70 years old). This study investigated the causes of hospital admission among patients with ESKD one year before and two years after they received hemodialysis. This study’s results revealed hypertension to be the most common comorbidity. Regarding the cause of admission, pneumonia was more prevalent in older than in younger patients. Moreover, changes in the ICD-9-CM codes of native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were significantly correlated with age. Therefore, when administering comprehensive nursing care and treatment for ESKD, clinicians should not only focus on comorbidities but also consider factors (e.g., age) that can affect patient prognosis.

May Coronary Artery Bypass Grafting Affect Native Coronary Atherosclerosis progression?

Background: Coronary artery bypass grafting (CABG) continues to be the best standard in the management of severe coronary artery disease (CAD), providing good symptom management and life extension. Although CABG was first performed by reversed saphenous veins (SVGs), surgeons have increasingly adopted arterial conduits because of their longer-term patency and resistance to atherosclerosis. CABG's efficacy may potentially be affected by the extension of atherosclerosis in the native coronary arteries. Few researches have investigated the long-term angiographic disease progression of native coronary arteries after surgical revascularization, or the variables that may impact this progression. Proximal native disease progression was presented to be two to six times more common than distal disease progression, with greater rates of progression in coronaries bypassed by SVGs than arterial grafts. The goal of this research was to determine influence of CABG on the extension of native coronaries atherosclerosis.&#x0D; Methods: This prospective study was established on 25 patients who were diagnosed to have ischemic heart disease in cardiothoracic surgery department in Faculty of Medicine Menoufia University.&#x0D; Results: The study showed that according to the risk factors among the studied cases, smoking was (60%), Dyslipidemia was (32%), HTN was (32%) and Diabetes was (32). According to grafts in proximal lesions, there was progression of atherosclerosis up to total occlusion, but in Distal lesions, there was significant regression of atherosclerosis. As result, there was statistically significant difference between proximal with distal lesions. Also, study showed that there was a significant difference between left system (LAD, D, OM) in comparison with right system (PDA) regarding distal lesion. Our results showed that univariate logistic regression analysis for progression in distal lesion regarding Dyslipidemia and Diabetes.&#x0D; Conclusion: Progression of disease is more evident in coronary segment proximal to anastomosis, while regression of disease is more evident in coronary segment distal to anastomosis with statistically significant difference between them, also the risk of disease progression post CABG was found to be multifactorial, as certain risk factors can affect progression of the disease as Diabetes mellitus and dyslipidemia that were of statistically significance.

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches.

Despite the dramatic improvements of revascularization therapies occurring in the past decades, a relevant percentage of patients treated with percutaneous coronary intervention (PCI) still develops stent failure due to neo-atherosclerosis (NA). This histopathological phenomenon following stent implantation represents the substrate for late in-stent restenosis (ISR) and late stent thrombosis (ST), with a significant impact on patient’s long-term clinical outcomes. This appears even more remarkable in the setting of drug-eluting stent implantation, where the substantial delay in vascular healing because of the released anti-proliferative agents might increase the occurrence of this complication. Since the underlying pathophysiological mechanisms of NA diverge from native atherosclerosis and early ISR, intra-coronary imaging techniques are crucial for its early detection, providing a proper in vivo assessment of both neo-intimal plaque composition and peri-strut structures. Furthermore, different strategies for NA prevention and treatment have been proposed, including tailored pharmacological therapies as well as specific invasive tools. Considering the increasing population undergoing PCI with drug-eluting stents (DES), this review aims to provide an updated overview of the most recent evidence regarding NA, discussing pathophysiology, contemporary intravascular imaging techniques, and well-established and experimental invasive and pharmacological treatment strategies.

EVALUATION OF QUALITY OF LIFE INDICATORS IN NSTEMI PATIENTS DEPENDING ON PLASMA LEVEL ST2, NATURE OF CORONARY ARTERIES LESION AND OTHER CLINICAL CHARACTERISTICS

Introduction. The prevalence of myocardial infarction and its leading role in the structure of overall and cardiovascular mortality encourages the search for predictors of adverse disease and the search for optimal means to prevent adverse events and improve the quality of life of this category of patients. The aim of the study – to evaluate quality of life in NSTEMI patients based on plasma ST2 levels, the nature of coronary artery disease, and other clinical characteristics. Research Methods. The study involved 200 patients with NSTEMI aged 38 to 80 years. All patients were examined according to the current treatment protocol for patients with acute myocardial infarction without ST segment elevation, plasma ST2 levels were determined and quality of life was assessed using the MIDAS-35 questionnaire. Results and Discussion. Spearman's rank correlation showed that the level of physical activity (the first subscale of MIDAS-35) of patients with NSTEMI is directly correlated with the presence of frequent ventricular extra­systoles and paroxysms of ventricular tachycardia recorded during ECG monitoring on day 1 of NSTEMI, the seve­rity of coronary artery lesions and plasma ST2 levels determined on the 1st day of hospitalization. Similar patterns are found in subscales 2, 4, 5. Subscale 6 revealed the presence of a correlation only with the presence of frequent ventricular tachycardia. Subscales 3 and 7 did not show correlations with the studied parameters. Conclusions. Elevated ST2 levels, hemodynamically significant coronary artery lesions and the presence of acute arrhythmias in the early period of NSTEMI have been found to significantly affect quality of life as determined by the MIDAS-35 questionnaire. The impact on remodeling processes and the strategy of early invasive treatment in patients with NSTEMI will not only reduce the likelihood of complications, but also improve the quality of life of this category of patients.

Bypass Grafting and Native Coronary Artery Disease Activity

ObjectivesThe aim of this study was to describe the potential of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BackgroundAs well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis. MethodsPatients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. ResultsAmong 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. ConclusionsNative coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.

Time-resolved fluorescence immunoassay (TRFIA) for the simultaneous detection of hs-CRP and lipoprotein(a) in serum.

Elevated serum high-sensitivity C-reactive protein (hs-CRP) and lipoprotein(a) (Lp(a)) levels are associated with the development of native coronary atherosclerosis. We aimed to establish a new method for the simultaneous detection of hs-CRP and Lp(a) to predict the development of atherosclerosis. A one-step time-resolved fluorescence immunoassay (TRFIA) with europium(III) (Eu3+ ) or samarium(III) (Sm3+ ) labels was established, and the performance of this TRFIA (in terms of sensitivity, specificity, accuracy, and cutoff values) was evaluated using clinical serum samples and compared with those of registered kits. The sensitivity was 0.052μg/ml for hs-CRP and 0.64μg/ml for Lp(a). The intra-assay and inter-assay cross-reactivities (CVs) were very low, ranging from 2.05% to 4.67% for hs-CRP and from 2.42% to 6.43% for Lp(a). The CVs were very low (<0.34% and <2.65%, respectively) with five interferents. Additionally, there was a high Pearson coefficient between the present TRFIA method and the registered kits (R2 = 0.9967 and 0.9906, respectively). These data indicate that this study developed a TRFIA method that can be used for the quantitative detection of hs-CRP and Lp(a) in serum with high sensitivity, specificity, and accuracy. This TRFIA provides a new method for predicting the development of atherosclerosis.