Percutaneous Coronary Intervention Research Articles

Wire Escalation And De-escalation Techniques in Antegrade and Retrograde Approaches to Chronic Total Occlusion Percutaneous Coronary Interventions

Coronary chronic total occlusions (CTO) are frequently identified during coronary angiography and remain the most challenging subset of coronary artery lesions to treat; however, advancements in techniques and materials have greatly improved success rates. Various crossing algorithms have been developed to standardise the approach to CTO interventions based on angiographic criteria. Antegrade wiring is typically the initial strategy of choice, particularly in cases of short and straight CTOs with tapered proximal cap. Similarly, retrograde crossing can be achieved through retrograde wiring, although this approach has a very low success rate. This review aims to outline how to perform a CTO analysis, clarify the fundamental features of guidewires and provide insights into both antegrade and retrograde wire-based approaches.

Abstract 4135434: Effect of early nutritional guidance for patients with acute myocardial infarction: A single center retrospective cohort study

Introduction/Background: Acute myocardial infarction (AMI) stands as a major global cause of mortality. Various intervention strategies, such as pre-hospital care, reperfusion therapies, pharmacological interventions, dietary modifications, and exercise therapies, have been researched to improve patient prognosis. Research Question: There remains a lack of evidence regarding the impact of early nutritionist-led dietary guidance on the prognosis of AMI patients. Aim: This study aimed to elucidate whether nutritional guidance by nutritionists who have national qualifications would improve the mortality and the primary composite endpoint (including acute decompensated heart failure, stroke, and acute coronary syndrome) of patients following an acute myocardial infarction. Methods/Approach: A retrospective cohort study enrolling 409 AMI patients who underwent emergency percutaneous coronary interventions between September 1, 2015, and October 31, 2023. Nutritionists guided 223 patients (54.5%) during hospitalization in this study. The nutritional guidance used in our study was also based on the definition of adequate caloric intake of 25–30 kcal per ideal body weight (kg). Under an appropriate total energy intake, a fat energy ratio of 20–25% and a carbohydrate energy ratio of 50–60% are recommended, with protein and lipid restrictions depending on the disease state. Results/Data: During a median follow-up of 39 months, 24 cases of all-cause mortality (5.9%) and 6 cases of cardiovascular mortality (1.5%) were recorded. Kaplan–Meier curves demonstrated significantly higher incidence rates of death and primary composite endpoints among patients without nutritional guidance during hospitalization. The multivariate Cox regression model revealed early nutritional guidance as a significant predictor for long-term mortality but not for primary composite endpoints. Furthermore, undernourished patients, defined as those with a geriatric nutritional risk index of 98 or less, showed a similar prognosis to those with good nutritional status after receiving nutritional guidance, indicating that nutritional guidance improves prognosis. Conclusion: Nutritionist-led dietary guidance for patients with AMI can potentially improve total mortality and is expected to be more effective in undernourished patients. Further research is warranted to explore the physiological impacts of improved diets resulting from such guidance and their effects on enhancing prognosis.

Abstract 4136767: Racial/Ethnic and Sex Disparities in the Outcomes and Treatment of In-Hospital Cardiac Arrest: A Nationwide Analysis From the United States

Background: In-hospital cardiac arrest (IHCA) is associated with significant morbidity and mortality. The relationships of race/ethnicity and sex to outcomes and treatment patterns among patients with IHCA remain poorly understood. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020 to identify adult patients with IHCA and compare in-hospital outcomes stratified by race/ethnicity (White, Black, Hispanic) and sex. The primary outcome was in-hospital mortality. Secondary outcomes included rates of in-hospital procedures. Multivariable logistic regression was used to adjust for potential confounders. Results: Among 207,770 patients with IHCA, 26.6% had ventricular tachycardia/fibrillation (VT/VF) and 73.4% had pulseless electrical activity (PEA)/asystole. In the VT/VF subgroup, Black males (aOR 1.42, 95% CI 1.21-1.66), Black females (aOR 1.25, 95% CI 1.05-1.50), and Hispanic females (aOR 1.30, 95% CI 1.01-1.66) had higher odds of mortality compared to White males (Figure 1). In the PEA/asystole subgroup, Black males (aOR 1.25, 95% CI 1.11-1.39) and Hispanic males (aOR 1.22, 95% CI 1.07-1.40) had higher odds of mortality, while White females had lower odds (aOR 0.88, 95% CI 0.82-0.94) compared to White males (Figure 2). Black patients were less likely to receive percutaneous coronary intervention (aOR 0.53, 95% CI 0.43-0.66 for males; aOR 0.54, 95% CI 0.42-0.69 for females) and coronary artery bypass grafting (aOR 0.50, 95% CI 0.30-0.82 for males; aOR 0.47, 95% CI 0.27-0.81 for females) compared to White males in VT/VF arrests. Additionally, Black males had the highest adjusted odds of renal replacement therapy in VT/VF arrests (aOR 1.47, 95% CI 1.21-1.80), while Hispanic males had the highest adjusted odds in PEA/asystole arrests (aOR 1.49, 95% CI 1.27-1.74) compared to White males. The remaining outcomes of interest in both VT/VF and PEA/asystole arrests are shown in Figure 1 and Figure 2 respectively. Conclusion: Significant racial/ethnic and sex disparities exist in outcomes and treatment patterns among patients with IHCA, with differences observed in both VT/VF and PEA/asystole subgroups. Targeted efforts and further studies are needed to better understand and address these disparities and improve outcomes in these severely ill patients.

Abstract 4134641: Door-in to door-out time and in-hospital mortality in patients with ST-elevation myocardial infarction

Background: Although current guidelines recommend achieving a door-in to door-out (DIDO) time within 30 minutes for 75% of patients with ST-elevation myocardial infarction (STEMI) who require interhospital transfer for primary percutaneous coronary intervention (PCI), disparities between guidelines and clinical performance persist. Methods: We analyzed the association between the DIDO time and in-hospital mortality using data from the Get With The Guidelines® – Coronary Artery Disease STEMI and NSTEMI Registry covering 232,935 admissions between the fourth quarter of 2019 and the third quarter of 2022. We determined the cut-off value of the DIDO time at which the odds of in-hospital mortality markedly increased by a likelihood ratio (LR) and an area under the curve (AUC) derived by generalized linear regression. Results: Of the 103,838 patients with STEMI, 23,865 (23%) required interhospital transfer. The median DIDO time was 63 (interquartile range 43–105) minutes and was within 30 minutes in 9% of cases. Generalized linear mixed models showed that a DIDO time delay of 5 minutes was significantly associated with higher in-hospital mortality (adjusted odds ratio [OR], 1.88; 95% confidence interval [CI], 1.56–2.27; p<0.001). The LR test and AUC showed that DIDO time cut-offs at 30, 42, 63, and 93 minutes were associated with increased in-hospital mortality. Compared with a reference DIDO time of within 30 minutes, the in-hospital mortality did not significantly differ for a DIDO time from 30 to 42 minutes (adjusted OR, 1.20; 95% CI, 0.83–1.73; p=0.340), but it was significantly higher for DIDO times from 42 to 63 minutes (adjusted OR, 1.48; 95% CI, 1.06–2.06; p=0.020), 63 to 93 minutes (adjusted OR, 1.89; 95% CI, 1.36–2.63; p<0.001), and over 93 minutes (adjusted OR, 2.85; 95% CI, 2.08–3.90; p<0.001). Conclusion: A delayed DIDO time was significantly associated with higher in-hospital mortality, particularly beyond 42 minutes.

A U-shaped relationship between the atherogenic index of plasma and repeated target vessel revascularization in patients undergoing percutaneous coronary intervention: a retrospective study

BackgroundAtherogenic index of plasma (AIP) has been recognized as a novel and practical marker for the assessment of cardiometabolic risk, but the relevance of AIP as a prognostic biomarker in coronary artery disease (CAD) remains debated. This study investigated the association between AIP and major adverse cardiac and cerebrovascular events (MACCEs) in CAD patients receiving percutaneous coronary intervention (PCI) with drug-eluting stents (DES).MethodsA total of 2,250 patients undergoing PCI with DES were included in this retrospective cohort study. The primary endpoint was MACCEs, encompassing acute myocardial infarction, repeat target vessel revascularization (TVR), stroke, and all-cause mortality. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic splines were applied to explore the dose–response associations. And subgroup analysis was conducted to evaluate potential relationship between AIP and MACCEs across different subgroups.ResultsDuring a medium follow-up of 29.8 (25.6–34.0) months, 106 (4.7%) patients experienced TVR. After adjusting for confounders, AIP (per 1 SD increase) was positively associated with TVR (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.01–1.58, P = 0.042). In females, there was a significant association (OR = 2.33, 95% CI = 1.40–3.98, P = 0.002), but no significant association was observed in males. There was an interaction between AIP and gender (P = 0.017). Restricted cubic spline analysis depicted a U-shaped relationship between AIP and TVR (Pnonlinear = 0.016), with an elevated risk evident from an AIP of 0.20.ConclusionAIP showed a U-shaped relationship with TVR in PCI patients with DES, particularly pronounced among females. We suggested that the AIP should be used as a plasma marker of key interest for preventing TVR after DES implantation in patients with CAD.

Performance Measures in the Management of ST-Segment Elevation Myocardial Infarction Patients at Manila Doctors Hospital

INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is a common and potentially fatal presentation of cardiovascular disease. Once a diagnosis is made, prompt intervention is crucial, with substantial effect on morbidity and even mortality. OBJECTIVE: The aim of this study was to assess the adherence of physicians of a tertiary care hospital to American College of Cardiology/American Heart Association and European Society of Cardiology performance measures for the management of acute STEMI patients. METHODOLOGY: This was a descriptive retrospective chart review of acute STEMI patients seen in a tertiary care hospital over a 2-year period. RESULTS: A total of 118 STEMI patients were included in the study. Mean age was 57.8 years with male predominance. High adherence rates (100% achievement score) to recommended discharge medications and counseling for smoking cessation were observed. However, performance measures for time to reperfusion therapy via percutaneous coronary intervention (average, 16.7% over 2 years) and referral to cardiac rehabilitation (average, 38.0%) were consistently low, although time to percutaneous coronary intervention improved from an average of 170 minutes to 142 minutes in the second year of this study. CONCLUSION: For 2 consecutive years, all STEMI patients seen in our institution were adequately managed with regard to recommended medications. All patients have been advised lifestyle change, particularly smoking cessation for current smokers. There is room for improvement with regards to time to reperfusion therapy and referral to cardiac rehabilitation. Some measures have been suggested, including shortening the time to secure patient consent. KEYWORDS: myocardial infarction, performance measures, STEMI

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.

How quitting, switching to e-cigarettes, or sticking to smoking shapes cardiovascular outcomes after percutaneous coronary intervention.

How quitting, switching to e-cigarettes, or sticking to smoking shapes cardiovascular outcomes after percutaneous coronary intervention.

Racial/Ethnic and Sex Disparities in the Outcomes and Treatment of In-Hospital Cardiac Arrest: A Nationwide Analysis From the United States.

In-hospital cardiac arrest (IHCA) is associated with significant morbidity and mortality. The relationships of race/ethnicity and sex to outcomes and treatment patterns among patients with IHCA remain poorly understood. We conducted a retrospective study using the National Inpatient Sample (NIS) database from 2016 to 2020 to identify adult patients with IHCA and examine associations between in-hospital outcomes and race/ethnicity (White, Black, Hispanic) and sex. The primary outcome was in-hospital mortality. Secondary outcomes included rates of in-hospital procedures. Multivariable logistic regression analysis was used to adjust for potential confounders. Among 207,770 patients with IHCA, 26.6% had ventricular tachycardia/fibrillation (VT/VF) and 73.4% had pulseless electrical activity (PEA)/asystole. For VT/VF arrest, Black males (aOR 1.42, 95% CI 1.21-1.66), Black females (aOR 1.25, 95% CI 1.05-1.50), and Hispanic females (aOR 1.30, 95% CI 1.01-1.66) had higher odds of mortality compared to White males (corresponding adjusted risk ratios (aRRs): 1.10 (CIs 1.06-1.14), 1.06 (1.02-1.11), and 1.08 (1.01-1.14), respectively). In the PEA/asystole arrest subgroup, Black males (aOR 1.25, 95% CI 1.11-1.39) and Hispanic males (aOR 1.22, 95% CI 1.07-1.40) had higher odds of mortality (corresponding aRRs 1.04 (1.02-1.06) and 1,04 (1.01-1.06), respectively). Black patients with IHCA were less likely to receive percutaneous coronary intervention, coronary artery bypass grafting, and mechanical circulatory support compared to White males. Significant racial/ethnic and sex disparities exist in outcomes and treatment patterns among patients with IHCA. Targeted efforts and further studies are needed to better understand and address these disparities and improve outcomes.

Safety and Efficacy of Aspiration Thrombectomy With Intracoronary Tirofiban in Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

BACKGROUND: Primary percutaneous coronary intervention (PPCI) may be complicated by heavy intracoronary thrombus burden leading to decrease in myocardial perfusion and increase in infarct size. The current meta-analysis aims to investigate the clinical outcomes of aspiration thrombectomy (AT) with intracoronary tirofiban during PPCI. METHODS: A systematic search for randomized controlled trials that evaluate the safety and efficacy of AT with intracoronary tirofiban in ST-elevation myocardial infarction (STEMI) patients who underwent PPCI was done using PubMed, MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov., and Herdin PH. Studies included those published between 2010 and 2023 and involved human subjects. Search terms included “aspiration thrombectomy,” “intracoronary tirofiban,” “primary percutaneous coronary intervention,” and “STEMI patients.” RESULTS: Four randomized controlled trials (n = 490 participants) were included in this metaanalysis comparing AT with intracoronary tirofiban versus AT alone in STEMI patients undergoing PPCI. The results revealed no statistically significant difference in ST-segment resolution (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97–1.08; P = 0.41, I2 = 0%), myocardial blush grade 2–3, (RR, 1.04; 95% CI, 0.97–1.12; P = 0.22, I2 = 62%), and Thrombolysis In Myocardial Infarction 3 flow (RR, <1.0; 95% CI, 0.95–1.04; P = 0.87). The occurrence of major adverse cardiovascular events did not significantly differ between the two groups (RR, 0.46; 95% CI, 0.19–1.09; P = 0.08, I2 = 0%). There was no statistically significant difference in terms of bleeding when combining intracoronary tirofiban to standard medical therapy (RR, 1.35; 95% CI, 0.64–2.84; P = 0.78, four trials [490 patients]). CONCLUSION: In PPCI, major adverse cardiovascular event outcomes of AT with intracoronary tirofiban were similar to those for AT alone in terms of improving myocardial perfusion in STEMI patients without increasing the risk for bleeding. Our meta-analysis suggests that AT alone may be the more acceptable standard during PPCI when encountering heavy thrombus burden. Future validated studies may help further investigate the strategy of adding tirofiban during AT.

Bypassing Emergency Service: Decoding the Drivers of Self-Referral During Acute Myocardial Infarction on Rural Areas in Sachsen-Anhalt, Germany

Background/Objectives: the timely and effective management of acute myocardial infarction (AMI) is crucial to improve patient outcomes. ‘Self-Referral’ is defined as instances either where patients arrive at the hospital by their own means or are transported by someone else, rather than through professional emergency medical services. This approach can lead to treatment delays and potentially worsen outcomes. This study aims to identify the factors associated with the choice of self-referral among patients with AMI in Saxony-Anhalt, Germany. Methods: We used the data from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA), which included 4044 patients with confirmed acute myocardial infarction (AMI), including 48.7% from urban areas (city of Halle) and 51.3% from rural areas (Altmark). The gender distribution was 65% male and 35% female, covering an age range from 25 to over 80 years. Multivariable logistic regression identified factors associated with self-referral and its impact on reaching a hospital with percutaneous coronary intervention (PCI) capability. Results: Rural residents were more likely to self-refer compared to those in urban settings (adjusted odds ratio 2.43 [95% CI: 2.00–2.94]). Odds of self-referral decreased with age, while metabolic factors, including hypertension, high body mass index (BMI), and diabetes, as well as sex were not associated with self-referral. Self-referral did not increase the odds of arriving in a hospital without PCI capability. (Adjusted odds ratio 1.12 [95% CI: 0.85–1.47]). Furthermore, in cases of self-referral, women did not have a disadvantage in reaching a hospital with PCI (0.91; 0.59–1.41) compared to men. However, in medically attended transports, women were at a disadvantage (odds ratio: 1.33; 95% CI: 1.06–1.67). Conclusions: These findings highlight the need for public education on self-referral and for medical personnel training to prevent gender bias in AMI transport to PCI-capable hospitals.

Impact of treatment management on the hospital stay in patients with acute coronary syndrome

BackgroundThe length of hospital stay in patients with acute coronary syndrome (ACS) is crucial for determining clinical outcomes, managing healthcare resources, controlling costs, and ensuring patient well-being. This study aimed to explore the impact of treatment approaches on the length of stay (LOS) for ACS patients.MethodsA total of 7109 ACS cases were retrospectively recruited from a hospital between 2018 and 2023. Demographical baseline data, laboratory examinations, and diagnostic and treatment information of the included subjects were extracted from electronic medical records to investigate the factors contributing to extended hospitalization and further explore the impact of treatment management on the LOS.ResultsAdvanced age, female sex, and elevated levels of B-type natriuretic peptide, C-reactive protein and higher low-density lipoprotein cholesterol were identified as risk factors for extended hospitalization. At the 0.2–0.9 quantile of LOS, compared with the non-invasive group, the percutaneous transluminal coronary angioplasty group and the stent implantation group exhibited decreases in LOS of 0.37–2.37 days and 0.12–2.28 days, respectively. Stratified analysis based on diagnosis showed that percutaneous coronary intervention decreased hospitalization time in the high quantile of LOS but conversely increased it in the low quantile.ConclusionPercutaneous coronary intervention is important for reducing hospitalization duration, particularly for patients susceptible to prolonged stays. Early and assertive management intervention, incorporating elements such as lipid-lowering therapy, and anti-inflammatory agents, is essential for improving outcomes within high-risk groups.

Effect of statin on long-term outcomes in persistent tobacco users receiving percutaneous coronary intervention: A longitudinal, retrospective cohort study.

The role of statins in improving cardiovascular outcomes is well established, but little is known about their impacts on long-term outcomes in persistent tobacco users with stable coronary artery disease (CAD) who receive percutaneous coronary intervention (PCI). A population of persistent smokers with CAD treated by PCI was analyzed. From 2012 through 2019, a cohort of 907 persistent tobacco users with stable CAD undergoing PCI were enrolled from the inpatient department of Taichung Tzu Chi Hospital, Taiwan. We surveyed statin users and non-statin users after index PCI, and general characteristics, major risk factors, angiographic findings, and long-term clinical outcome were compared. Kaplan-Meier curve was used to compare the survival difference and Cox proportional hazard model was used to analyze the predictors for all-cause mortality and major adverse cardiovascular events, including cardiovascular (CV) mortality, myocardial infarction, and repeated PCI procedures. The statin group had a higher average total cholesterol (P < .01) and low-density lipoprotein cholesterol (LDL-C) level (P < .01) and was younger (P < .01) than the non-statin group. Ninety-six point one percent patients in the statin group had a LDL-C level below 100 mg/dL after treatment. They also had a more frequent history of acute coronary syndrome and lower prevalence of chronic kidney disease than the non-statin group (both P < .01). Freedom from all-cause and CV mortality were lower in the non-statin group than the statin group (both P < .01). After adjustment for age and chronic kidney disease, statin treatment no longer reduced the risk of CV mortality (hazard ratio: 0.32, 95% confidence interval = 0.07-1.49), but was still associated with a reduction in all-cause mortality (hazard ratio: 0.27, 95% confidence interval = 0.10-0.75). In persistent tobacco users undergoing PCI, patients treated with statin for LDL-C values above 100 mg/dL had a similar level of cardiovascular protection as those with LDL-C below 100 mg/dL and without statin treatment. Therefore, smoking attenuates pleiotropic effect of statin. Nevertheless, statin therapy was still associated with a reduction of all-cause mortality.

The Incidence of Contrast-Induced Nephropathy in Patients on Sodium-Glucose Cotransporter-2 Inhibitors Following Percutaneous Coronary Intervention: An Observational Analysis.

The purpose of this study is to compare the incidence of contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) in patients on sodium-glucose cotransporter-2 (SGLT-2) inhibitors prior to the procedure with a matched cohort of patients not receiving sodium-glucose cotransporter-2 inhibitor therapy. In this retrospective observational study, patients were eligible for inclusion if they underwent PCI at any of the included study centers within the study time period. Patients were assigned to either the SGLT-2 inhibitor group or control group depending on the documentation of receiving any SGLT-2 inhibitors within 24h prior to PCI. Propensity matching was utilized to determine the final subjects to include for comparison. The primary outcome was the incidence of CIN. A total of 192 patients (96 in each group) were matched after exclusion criteria were applied. The incidence of contrast-induced nephropathy was similar between groups, occurring in 8 (8.3%) patients in the SGLT-2 inhibitor group and 6 (6.3%) patients in the comparator group (p = 0.58). There was also no difference between groups in the change in serum creatinine following PCI. Based on our analysis, we did not identify any risk of CIN associated with SGLT-2 inhibitor use prior to PCI. Based on these results and in conjunction with previously published literature, the use of SGLT-2 inhibitors appears safe prior to PCI. These results still warrant further investigation with prospective adequately powered studies to evaluate the incidence of CIN with SGLT-2 inhibitor use in the setting of PCI.

Effect of Baduanjin exercise on acute myocardial infarction in patients with anxiety and depression after percutaneous coronary intervention: A randomized controlled trial.

Acute myocardial infarction (AMI) is the most severe type of coronary heart disease and patients often require percutaneous coronary intervention (PCI). However, anxiety and depression are common complications of PCI. This study conducted a prospective randomized controlled trial to investigate the effectiveness of Baduanjin exercise in improving cardiac function and alleviating symptoms of anxiety and depression in patients who underwent PCI for AMI. Patients with AMI (n = 120) who underwent PCI at the Cardiology Department of The First Affiliated Hospital of Guangzhou University of Chinese Medicine between September 2020 and June 2021 were included. Participants were divided into a control group (moderate intensity walking) and a Baduanjin exercise group. The treatment period was 8 weeks, with follow-ups at weeks 4 and 8. Improvement of cardiac structure and function indices was measured by echocardiography. Physical function was assessed using the 6-minute walk test. Mental state was assessed using the Seattle Angina Questionnaire, Hamilton Anxiety Scale, and Hamilton Depression Scale before and after exercise. Compared to the control group, the Baduanjin exercise group showed improvement in change in left ventricular end-diastolic diameter (-1.0 ± 3.4 vs -2.3 ± 2.7 mm, respectively; P = .02), left ventricular ejection fraction (6.8 ± 4.2 vs 4.5 ± 4.3%, respectively; P = .002), angina stability (42.5 ± 31.7 vs 33.3 ± 29.7, respectively; P = .11), 6-minute walk test (118.4 ± 49.1 vs 88.3 ± 40.2 m, respectively; P < .001), and Hamilton Anxiety Scale (6.7 ± 2.6 vs 5.3 ± 2.6, respectively; P = .003), and Hamilton Depression Scale (7.6 ± 4.1 vs 4.8 ± 2.1, respectively; P < .001) scores. Baduanjin exercise for 8 weeks improved the cardiac function and mental state of patients with anxiety and depression after PCI for AMI. Through this study, we aim to provide reliable evidence in support of the beneficial effects of Baduanjin exercise on cardiac function and anxiety-depression, contributing to evidence-based medicine.

Study on the management effect of chronic disease intelligent information management platform in post percutaneous coronary intervention patients.

In 2019, approximately 330 million individuals in China were affected by cardiovascular diseases, with 11.4 million cases specifically attributed to coronary artery disease (CAD). A national public health report indicated that the mortality rate for CAD ranged from 121.59 to 130.14 per 100,000 individuals in 2019. The treatments for CAD include lifestyle changes, medications, percutaneous coronary intervention (PCI) and coronary artery bypass grafting. To investigate the management effect of a digital health program in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). This retrospective study compares blood pressure, blood glucose, low-density lipoprotein cholesterol (LDL-C), medication adherence, lifestyle modification, and readmission rate between digital health users and traditional follow-up in post-PCI CAD patients. In this study of 698 CAD patients, the 6-month readmission rate of all patients was 27.4%, with digital health users showing lower rates than those in traditional follow-up (22.6% vs. 32.1%, p= 0.005). Digital health users had significantly higher target achievements rates in blood pressure (79.7% vs. 54.7%, p< 0.001), blood glucose (98.9% vs. 82.5%, p< 0.001) and LDL-C level (71.3% vs. 52.7%, p< 0.001) at 6-month post-PCI. The digital health group had more patients adopting lifestyle changes, including quitting smoking, maintaining a healthy diet, and exercising regularly. In risk factor analysis, digital health utilization (OR = 0.60, 95%CI: 0.40-0.90, p= 0.014) and multivessel disease (double: OR = 1.72, 95%CI: 1.09-2.72, p= 0.02; triple: OR = 2.59, 95%CI: 1.61-4.17, p< 0.001) were independent predictors of CAD-related cardiovascular readmissions. Post-PCI patients using digital health platforms exhibited improved blood pressure, glucose, and LDL-C control, greater treatment adherence, enhanced lifestyle changes, and reduced six-month readmission rates versus those with traditional follow-up.

Predictors of acute kidney injury in chronic kidney disease patients treated for cardiovascular disease in the cardiac intensive care unit (MORCOR-TURK subgroup analysis).

Acute kidney injury (AKI) is a common complication in chronic kidney disease (CKD) patients in the cardiac intensive care unit (cardiac ICU). In this study, we aimed to identify predictors of AKI in CKD patients treated in the cardiac ICU for cardiovascular diseases. The MORCOR-TURK trial was conducted as a multicenter, prospective, cross-sectional, and noninterventional investigation. A total of 3157 patients treated in the cardiac ICU were enrolled from 50 centers over the course of one month. In this subgroup analysis, 615 patients with CKD treated in the cardiac ICU for cardiovascular disease were included in the study. The primary outcome of this study was the development of AKI. During hospitalization, patients who developed AKI were identified. AKI developed in 288 patients (46%). After multivariable analysis, decompensated heart failure (OR: 3.72, p = 0.005), primary percutaneous coronary intervention (OR: 3.75, p = 0.004), non-primary percutaneous coronary intervention(OR: 2.85, p = 0.033), troponin levels (OR: 1.04, p = 0.031), and need for mechanical ventilation (OR: 3.11, p < 0.001) were identified as independent predictors of AKI development in CKD patients. Our efforts to identify AKI predictors in cardiac ICU patients with CKD have yielded directly applicable results in clinical practice. AKI can be prevented by developing personalized strategies to follow up and treat cardiac ICU patients with CKD who have decompensated heart failure, are undergoing percutaneous coronary intervention (primary and non-primary), have high troponin levels, and need mechanical ventilation.

Coronary microvascular obstruction in percutaneous coronary interventions in myocardial infarction patients: a comprehensive approach to prevention and treatment

Coronary microvascular obstruction in percutaneous coronary interventions in myocardial infarction patients: a comprehensive approach to prevention and treatment

Serum calcium-magnesium ratio at admission predicts adverse outcomes in patients with acute coronary syndrome.

Evidence from observational studies suggests that increased calcium exposure may elevate the risk of adverse events in patients with coronary artery disease, while magnesium may exert a protective effect on disease risk. However, there have been limited investigations into the relationship between these minerals and acute coronary syndrome (ACS). Therefore, this study aimed to explore the association between the Serum calcium-magnesium ratio (Ca/Mg ratio) in patients with acute coronary syndrome and their clinical outcomes. This retrospective analysis reviewed the clinical data of 1,775 patients with ACS who underwent coronary angiography and/or percutaneous coronary intervention (PCI) at the Fujian Heart Center between May 2017 and December 2022. The patients were categorized into four groups based on their Ca/Mg ratio at admission (Group 1, ≤2.373, n = 443; Group 2, 2.374-2.517, n = 442; Group 3, 2.518-2.675, n = 446; Group 4, ≥2.676, n = 444). Single-factor analysis and multivariate logistic regression were employed to analyze the clinical characteristics and postoperative clinical outcomes of patients in different groups. The primary outcome included major adverse cardiovascular and cerebrovascular events (MACCEs), while the secondary outcomes included contrast-induced nephropathy (CIN)、all-cause rehospitalization raten and hematorrhea. Univariate analysis showed that the patients had a mean age of 64.50±10.79 years, with 370 female patients (20.8%). Additionally, 1,158 patients had hypertension (65.2%), and 710 patients had diabetes (40.5%). Univariate analysis showed an inverse relationship between the serum calcium-to-magnesium ratio and all-cause in-hospital mortality, with patients in the lowest quartile having the highest mortality rate. Multivariate analysis showed that the Ca/Mg ratio at admission was independently associated with MACCEs. Among them, this ratio was inversely associated with all-cause mortality [adjusted odds ratio (aOR) 0.07; 95% CI 0.01-0.63; P<0.05] and positively associated with new-onset atrial fibrillation (aOR 1.86; 95% CI 1.08-3.21; P<0.05). Additionally, the Ca/Mg ratio was positively correlated with an increased risk of postoperative major bleeding (aOR 6.58; 95% CI 1.43-30.29; P<0.05). In this large retrospective study, serum calcium and magnesium levels at admission were significantly associated with adverse outcomes in patients with ACS. The Ca/Mg ratio was identified as a reliable predictor of poor prognosis in ACS patients.

Relationship of Serum Fibroblast Growth Factor 23, Hypoxia-Inducible Factor-1α, and Klotho with In-Stent Restenosis in Elderly Patients with Coronary Artery Disease after the Treatment of Percutaneous Coronary Intervention.

In-stent restenosis (ISR) commonly occurs in elderly patients with coronary artery disease (CAD) after percutaneous coronary intervention. Atherosclerosis in elderly patients may be the leading cause of ISR. Therefore, we aim to explore the relationship between vascular calcification-associated factors and ISR occurrence. Elderly patients were enrolled according to standard inclusion and exclusion criteria. The serum fibroblast growth factor 23 (FGF23), hypoxia-inducible factor-1α (HIF-1α), and Klotho levels were determined using an enzyme-linked immunosorbent assay. The degree of coronary artery stenosis of the patients with CAD before operation was assessed using the Gensini score. The correlation was analyzed using Pearson analysis. The prediction value was evaluated using receiver operating characteristic (ROC) curve analysis. The patients with CAD were classified into the ISR group with 97 cases and the non-ISR (NISR) group with 349 cases. The Gensini score, serum FGF23, and HIF-1α levels increased while Klotho levels decreased in patients with CAD of the ISR group compared with those of the NISR group. Pearson analysis showed that FGF23 and HIF-1α positively correlated while Klotho negatively correlated to the Gensini score. ROC analysis showed all three factors could effectively predict the occurrence of ISR. Furthermore, the joint had a more effective prediction value for ISR occurrence. The dynamic analysis presented that the serum FGF23 and HIF-1α levels dramatically increased while Klotho levels decreased in patients with CAD after 1-year follow-up. Serum FGF23 and HIF-1α positively correlated while serum Klotho negatively correlated to ISR. Conclusively, these three factors effectively predicted the occurrence of ISR.