Significant Coronary Artery Lesions Research Articles

Can Severe Hypertriglyceridemia Cause Angina in the Absence of Significant Coronary Artery Lesions?

Understanding the effects of severely elevated triglyceride levels on coronary endothelial function.Prevention of harmful effects resulting from severely elevated triglyceride levels.

First experience of implantation of a new-generation bioresorbable stent in a young patient with coronary artery disease: a case report

Implantation of a drug-eluting stent into the area of hemodynamically significant coronary artery lesion is a generally accepted and widespread method of coronary artery disease (CAD) treatment. However, rigid metallic frame in artery is associated with disrupted vascular biomechanics and neointimal proliferation in response to foreign material. These processes can lead to restenosis and/or late thrombosis of the implanted stent and, as a consequence, to the recurrence of CAD symptoms, as well as to adverse cardiovascular events. One of the options for solving the above problems is the implantation of bioresorbable stents. This technique already has an evidence base and is increasingly being introduced into routine clinical practice in certain groups of patients. The article presents a case of successful balloon angioplasty and stenting of the right coronary artery with a new-generation bioresorbable stent in a young patient with CAD.

The clinical value of noninvasive left ventricular myocardial work in the diagnosis of myocardial ischemia in coronary heart disease: a comparative study with coronary flow reserve fraction.

The prompt and precise identification of hemodynamically significant coronary artery lesions remains an ongoing challenge. This study investigated the diagnostic value of non-invasive global left ventricular myocardial work indices by echocardiography in functional status of coronary artery disease (CAD) patients with myocardial ischemia using fractional flow reserve (FFR) as the gold standard. A total of 77 consecutive patients with clinically suspected CAD were prospectively enrolled. All participants sequentially underwent echocardiography, invasive coronary angiography (ICA) and FFR measurement. According to the results of ICA, patients were divided into myocardial ischemia group (FFR ≤ 0.8, n = 27) and non-myocardial ischemia group (FFR > 0.8, n = 50). Myocardial work indices including global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), global positive work (GPW), global negative work (GNW), global systolic constructive work (GSCW) and global systolic wasted work (GSWW) were obtained by using the non-invasive left ventricular pressure strain loop (PSL) technique. Compared with the non-myocardial ischemia group, GWI, GCW, GPW and GSCW were significantly decreased in the myocardial ischemia group at either the 18-segment level or the 12-segment level (P < 0.001). At the 18-segment level, GWI < 1783.6 mmHg%, GCW < 1945.4 mmHg%, GPW < 1788.7 mmHg% and GSCW < 1916.5 mmHg% were optimal cut-off value to detect myocardial ischemia with an FFR ≤ 0.8. Global left ventricular myocardial work indices by echocardiography exhibited a good diagnostic value in patients with CAD and may have a good clinical significance for the screening of suspected myocardial ischemia.

Pentraxin 3 as a marker of development and severity of stable coronary artery disease

PurposeInflammation plays a crucial role in the development of atherosclerotic plaques. Pentraxin 3 (PTX3) is produced at the site of inflammation and has been identified as a specific marker of atherosclerosis, vascular inflammation, and progression of the coronary artery disease (CAD).The aim of the study was to establish if PTX3 has potential relations with classical markers of cardiovascular risk, and if PTX3 may act as an independent risk factor of CAD occurrence and advancement. Materials and methodsThe study included 98 patients with stable CAD confirmed in coronary angiography (CAD group) (median age 65 interquartile range [IQR] 61–72 years; 72 ​% men). The control group consisted of 40 patients without CAD. ResultsThe CAD group had significantly higher PTX3 concentration compared to the control group. There was a correlation with age, male gender, lipid profile and intima-media thickness. There was no correlation between PTX3 concentration and the number of coronary vessels with significant atherosclerotic lesions and the advancement of atherosclerotic lesions on the Gensini scoring scale. The cut-off point was determined for 0.89 ​ng/ml for the exclusion of angiographically significant atherosclerotic lesions. ConclusionsPatients with CAD have significantly higher concentration of PTX3. There was no correlation between PTX3 and the advancement of angiographically significant atherosclerotic lesions in coronary arteries. Low PTX3 concentration may serve as an indicator for the absence of atherosclerosis.

Prevalence of Coronary Microvascular Dysfunction in Patients after Coronary Artery Bypass Grafting

The aim. To analyze the prevalence of coronary microvascular dysfunction (CMD) in patients with coronary artery disease after coronary artery bypass grafting (CABG).&#x0D; Materials and methods. The study was conducted in compliance with the provisions of the Declaration of Helsinki and was approved by the local ethics committee during 2018-2021. Due to recurrent complaints of discomfort/pain behind the sternum or shortness of breath during physical exertion in patients after CABG (average time of occurrence 18 ± 6 months after surgery), as well as positive or doubtful result of the stress testing, 31 patients were re-hospitalized for further examination. To diagnose CMD, echocardiography was performed with intravenous dipyridamole in order to determine the coronary flow reserve. The patency of the grafts was confirmed and newly formed hemodynamically significant coronary artery lesions were excluded during invasive coronary angiography.&#x0D; Results. The mean age was 61.2 ± 2.3 years, the majority of the patients were male (20 [64.5%]). The most common comorbid pathologies in the patients were: hypertension in 29 patients (93.5%), impaired glucose metabolism (diabetes/prediabetes) in 17 (54.8%) subjects, 13 (41.9%) patients had a history of myocardial infarction. Left ventricular ejection fraction according to echocardiography was reduced (less than 55%) in 5 (16.1%) of 31 patients, in others it was preserved. After CABG, there was a trend towards the coronary flow reserve increase, but no significant difference was found (1.89 ± 0.08 vs. 2.11 ± 0.13; p &gt; 0.05). The presence of CMD before and after CABG did not change significantly (13 [41.9%] vs. 12 [38.7%]; p &gt; 0.05).&#x0D; Conclusion. According to the results of the study, CMD is a common pathology in patients with obstructive coronary artery disease and is found in about 40% of patients with repeated myocardial ischemia after CABG. CABG did not affect the frequency of detection of CMD in patients with coronary artery disease before and after the operation.

Ventricular tachycardia ablation after myocardial infarction guided by cardiac magnetic resonance/multidetector computed tomography image integration

Abstract INTRODUCTION The persistent challenge of ventricular tachycardia (VT) ablation lies in the elevated morbidity and mortality due to the underlying disease progression and the complexity of the arrhythmogenic substrate. As imaging methods are evolving, substrate-based VT ablation is moving closer to the realm of precision medicine. CASE PRESENTATION A 52-year-old patient with a history of hypertension, type II diabetes mellitus, hyperlipidemia, and stage IIIB chronic kidney disease was referred to our hospital for sustained monomorphic VT. Upon admission, the patient was hemodynamically stable. Laboratory results indicated mild anemia, moderate renal dysfunction, and normal myocardial enzymes. ECG during sinus rhythm showed widespread repolarization abnormalities in the apical and postero-lateral leads. Echocardiography revealed mild left ventricular dysfunction and coronary angiography confirmed significant lesions in multiple coronary arteries that were treated with drug-eluting stents (DES). Cardiac MRI showed relatively limited areas of old myocardial infarctions in the left circumflex artery and left anterior descending artery territories, therefore we decided to perform VT ablation. We used a Carto 3 Biosense Webster electro-anatomical mapping system (EAM) guided by fusion imaging (cardiac MRI and multidetector computed tomography - MDCT) with the aid of ADAS 3D software. The voltage map created during sinus rhythm, was concordant with the lesions identified on LGE-CMR. Radiofrequency (RF) catheter ablation targeted abnormal signals from the EAM, which were identified based on conduction channels (CCs) from the fusion imaging. There was complete VT non-inducibility at programmed ventricular stimulation (PVS). At the 3-month follow-up, echocardiography showed a slight improvement in LVEF and repeated PVS proved persistent ventricular arrhythmia non-inducibility. CONCLUSION Substrate-based VT ablation in structural heart disease has greatly improved by high-resolution substrate imaging with detailed anatomy, allowing successful personalized treatment. There is room for further improvement in the near future with the contribution of artificial intelligence, possibly with a more targeted and automated VT ablation.

Algorithm for Diagnosis of Patients with Ischemic Heart Disease Depending on the Presence of Significant Coronary Artery Lesions

The aim. To analyze the structure of ischemic heart disease and the prevalence of myocardial ischemia with no ob-structive coronary arteries among patients who underwent elective coronary angiography.&#x0D; Materials and methods. We examined 1,200 patients with a clinical diagnosis of ischemic heart disease. After coro-nary angiography all the patients with non-stenotic coronary arteries underwent hyperventilation challenge test to ex-clude vasospastic angina and echocardiographic study with intravenous administration of dipyridamole to assess the index of coronary reserve and longitudinal strain.&#x0D; Results. The mean age of the study participants was 59.1 ± 4.2 years. The number of male and female subjects was comparable, amounting to 493 (48.8%) and 517 (51.2%), respectively. Stenotic coronary arteries were detected in 699 patients (74.1%). The number of women without hemodynamically significant lesions was twice as large than that of men (210 [67.5%] vs. 101 [32.5%]). Among the examined patients with non-stenotic atherosclerosis of the coronary arteries, 241 patients (77.4%) were diagnosed with coronary microvascular dysfunction, 19 (6.1%) with vasospasm of the coronary arteries, and 2 patients (0.6%) were diagnosed with a combination of vasospastic and microvascular angina. In 36 (73.5%) of 49 patients, a segmental decrease in longitudinal strain of the apex/individual apical segments of the left ventricle was found. In patients without obvious micro- and macrovascular pathology, the interventricular septum was significant enlarged. In 9 (18.4%) of 49 patients, a diagnosis of hypertrophic cardiomyopathy was established.&#x0D; Conclusion. Patients with ischemia with no obstructive coronary arteries require careful examination and compari-son of clinical signs with the results of objective tests. Understanding the prevalence and mechanisms of the problem is a key to improving the diagnosis and treatment of cardiovascular complications in this group.

Hibernation of the Conduction System and Atrioventricular Block Reversibility Following Revascularization in Patients without Acute Coronary Syndrome.

Although myocardial infarction (MI) is a reversible cause of atrioventricular (AV) block, the association of ischemia other than MI with AV block is unclear. The purpose of this study is to investigate this relationship. Among patients nominated for pacemaker implantation due to AV block in two centers from 2017-2020, 120 patients with significant coronary artery disease (CAD) in angiography were included in the study. Patients were divided into two equal groups based on their CAD treatment approach: drug therapy and revascularization. Coronary lesions were divided into three types based on location: left anterior descending artery (type 1), dominant coronary with AV node branch (type 2), and a combination of both (type 3). After coronary disease treatment, all patients were followed up with for 14 months, and AV block reversibility was assessed. There were 7 cases of block reversibility in the revascularization group (11.7%) and 1 case in the medical group (1.7%), which differed significantly (P = .02). A history of acute coronary syndrome, smoking, opium use, chronic kidney disease, hypertension, age, sex, and chronic obstructive pulmonary disease were not significantly associated with reversible block. Also, the type of coronary obstruction had no significant relationship with block reversibility (P = .3, .5, and .8 for type 1, type 2, and type 3, respectively). Hibernation due to ischemia can be a reversible cause of an AV blockage. Therefore, it is recommended that significant coronary artery lesions be revascularized before pacemaker implantation.

Diagnostic value of computed tomography myocardial perfusion imaging to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary artery disease.

Computed tomography myocardial perfusion (CT-MP) has reported usefulness in assessing hemodynamically significant epicardial coronary artery lesions. However, the diagnostic ability of the absolute coronary flow using CT-MP to detect coronary microvascular dysfunction (CMD) remains elusive. This prospective cohort study aimed to assess the diagnostic value of CT-MP in evaluating coexisting CMD in patients with functionally significant epicardial coronary stenosis and to analyze the predictive factors of lesions with CMD. Sixty-eight patients with chronic coronary syndrome (CCS) and de novo single functionally significant stenosis [fractional flow reserve (FFR) ≤0.80] were studied. CMD was defined as an index of microcirculatory resistance ≥25. We compare clinical background and CT-MP findings between patients with and without CMD (CMD, n=29; non-CMD, n=39). CT-MP, and quantitative and qualitative plaque assessments were included in computed tomography angiography assessment. Logistic regression analysis was performed to predict CMD. FFR, invasive wire-derived coronary flow reserve (CFRwire) and index of microcirculatory resistance were 0.68 [interquartile range (IQR), 0.59-0.74], 1.71 (IQR, 1.24-2.88), and 22.6 (IQR, 15.1-34.5), respectively. The rest and hyperemic-myocardial blood flow (MBF) and CT-MP-derived CFR (CFRCT-MP) were 0.83 (0.64-1.03) mL/min/g, 2.14 (1.30-2.92) mL/min/g, and 2.19 (1.44-3.37), respectively. In the territories with CMD, hyperemic-MBF was significantly lower than in those without [1.68 (IQR, 0.84-2.44) vs. 2.31 (IQR, 1.67-3.34) mL/min/g, P=0.015] and the prevalence of CFRCT-MP <2.0 was higher in the lesions with CMD than in those without (62.1% vs. 28.2%, P=0.011), while FFR values were similar. Fibrofatty and necrotic core component volume was greater in the vessels with CMD than in those without [31.8 (IQR, 19.0-48.9) vs. 25.1 (IQR, 17.2-32.1) mm3, P=0.045]. Multivariable logistic regression analysis showed that hyperemic-MBF and fibrofatty and necrotic core component volume were independent predictors of CMD territories [odds ratio (OR) =0.583; 95% confidence interval (CI): 0.355-0.958; P=0.033 and OR =1.040; 95% CI: 1.010-1.070; P=0.011]. Quantitative assessment of absolute coronary flow using pre-percutaneous coronary intervention (PCI) CT-MP, and comprehensive plaque analysis using computed tomography angiography may help detect coexisting subtended microvascular dysfunction in territories with functionally significant epicardial coronary lesions. Further studies are required to elucidate the clinical significance of coexisting CMD in patients with CCS undergoing PCI.

Clinical outcomes of physiology-guided coronary revascularization in patients undergoing TAVR

Abstract Background Coronary artery disease frequently coexists with severe aortic valve stenosis (AS). Although an fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in native coronary artery has been shown to be associated with better clinical outcomes as compared with an angiography-guided PCI, it is unknown whether this applies to severe AS patients. Purpose The purpose of this study was to compare the outcomes of different revascularization strategies between FFR-guided and angiography-guided PCI in AS patients undergoing transcatheter aortic valve replacement (TAVR). Methods In this retrospective analysis, we included 401 patients with severe AS undergoing TAVR who had coexisting coronary artery disease at invasive coronary angiography. A total of 156 patients was considered to have significant coronary artery lesions (&amp;gt;50% of diameter stenosis) due to the visual estimation. Patients were divided into 2 groups: physiology-guided (n=96, PCI performed in case of FFR ≤0.80 or diameter stenosis ≥90%) and angiography-guided PCI (n=60, PCI performed based on angiographic evaluation). Patients were clinically followed up and evaluated for the occurrence of major adverse cardiac and cerebrovascular event (MACCE; defined as a composite of death, non-fatal myocardial infarction, target vessel failure, and cerebrovascular accident) and major bleeding event defined as ≥VARC-3 type 2. Results Most lesions (62/96; 65%) in the physiology-guided group had negative results and were deferred. During a median follow-up of 743 [from 400 to 1,186] days, physiology-guided group had a significantly lower rate of MACCE compared with the angiography-guided groups (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.20-0.83; P&amp;lt;0.01). In addition, physiology-guided group showed a lower major bleeding event rate compared with the angiography-guided group (adjusted HR, 0.12; 95% CI, 0.04-0.40; P&amp;lt;0.01). Conclusion Physiology-guided PCI resulted in better clinical outcomes and lower bleeding events than angiography-guided PCI in patients with AS undergoing TAVR.

Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial.

Intravascular imaging-guided percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) showed superior clinical outcomes compared with angiography-guided PCI. However, the comparative effectiveness of OCT-guided and IVUS-guided PCI regarding clinical outcomes is unknown. In this prospective, multicenter, open-label, pragmatic trial, we randomly assigned 2008 patients with significant coronary artery lesions undergoing PCI in a 1:1 ratio to undergo either an OCT-guided or IVUS-guided PCI. The primary end point was a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year, which was powered for noninferiority of the OCT group compared with the IVUS group. Safety outcomes were also assessed. At 1 year, primary end point events occurred in 25 of 1005 patients (Kaplan-Meier estimate, 2.5%) in the OCT group and in 31 of 1003 patients (Kaplan-Meier estimate, 3.1%) in the IVUS group (absolute difference, -0.6 percentage points; upper boundary of one-sided 97.5% CI, 0.97 percentage points; P<0.001 for noninferiority). The incidence of contrast-induced nephropathy was similar (14 patients [1.4%] in the OCT group versus 15 patients [1.5%] in the IVUS group; P=0.85). The incidence of major procedural complications was lower in the OCT group than in the IVUS group (22 [2.2%] versus 37 [3.7%]; P=0.047), although imaging procedure-related complications were not observed. In patients with significant coronary artery lesions, OCT-guided PCI was noninferior to IVUS-guided PCI with respect to the incidence of a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year. The selected study population and lower-than-expected event rates should be considered in interpreting the trial. URL: https://www. gov; Unique number: NCT03394079.

Cardiac dysfunction and final outcome in correlation with serum cortisol level in active pulmonary tuberculosis: A single-center experience

Introduction: Although cardiac involvement is extremely rare in tuberculosis (TB), cardiac dysfunction is not uncommon. We have studied the prevalence of cardiac dysfunction in pulmonary TB with special emphasis on echocardiography, serum cortisol, and its correlation in cases with unstable cardiorespiratory parameters. Methods: A prospective observational and interventional study conducted in Pulmonary Medicine, MIMSR Medical College and Venkatesh Chest Hospital, Latur, India during July 2015 to December 2020, which included 800 cases of active pulmonary TB confirmed microscopically or with GeneXpert MTB/RIF, documented MTB genome in respiratory specimens’ sputum/induced sputum and bronchoscopy-guided bronchial wash, or bronchoalveolar lavage whenever necessary. Cases with known risk factors for cardiac disease and taking cardiac medicines and cases with pericardial effusion were excluded from study. Disproportionate tachycardia and tachypnea with or without shock and hypoxia were the key entry point criteria in this study. Chest radiograph, pulse oximetry, electrocardiography (ECG), sputum examination, cardiac enzyme studies (creatine phosphokinase MB [CPK-MB] and cardiac troponins), serum cortisol test, and echocardiography are done in all study cases during enrollment at 2 and 6 months of treatment with anti-TB medicines. Statistical analysis was carried out by chi-square test. Observations and analysis: Of the 800 cases with active pulmonary TB, cardiac dysfunction was documented in 26% cases, 44% were females, and 56% cases were older than 50 years. Echocardiographic abnormalities were documented such as global hypokinesia in 62% cases; depressed left ventricular systolic and diastolic function in 44 and 28% cases, respectively; dilated right atrium and right ventricle in 32% cases; and pulmonary hypertension in 6% cases. Serum cortisol level was significantly lower in cases with cardiac dysfunction (P &lt; 0.00001). Hypoxia had significant association with right and left heart dysfunction (P &lt; 0.00001). Cachexia, anemia, and hypoalbuminemia were documented to have significant association with cardiac dysfunction (P &lt; 0.00001). Treatment outcome showed significant improvement in cardiac function (P &lt; 0.00001). Coronary angiography did not show significant coronary artery lesions, and computed tomography (CT) pulmonary angiography did not show pulmonary embolism. Conclusion: Cardiac dysfunction in active pulmonary TB is underestimated and less evaluated routinely; disproportionate tachycardia and tachypnea with or without shock are clinical indicators to suspect early, especially in cases with risk factors such as advanced pulmonary TB on chest radiograph, cachexia with body mass index (BMI) &lt;18, advanced age, females, cases with anemia, and hypoalbuminemia. Echocardiography shows “global hypokinesia” as a predominant cardiac dysfunction in study cases, and right or left heart dysfunction depends on with or without hypoxia, respectively. Serum cortisol measurement will help in majority of the cases and a proportionate number of cases were having associated adrenal suppression.

What Is the Truth Behind Abnormal ECG Changes?

What Is the Truth Behind Abnormal ECG Changes?

Prediction of disorders with significant coronary lesions using machine learning in patients admitted with chest symptom.

BackgroundThe early prediction of significant coronary artery lesion, including coronary vasospasm, have yet to be studied. It is essential to discern the disorders with significant coronary lesions (SCDs) requiring coronary angiography from mimicking disease. We aimed to determine which of all clinical variables were more important using conventional logistic regression (cLR) and machine learning (ML).MaterialsOf 3382 patients with chest pain/discomfort or dyspnea in whom CAG was performed, 1893 were included. All clinical data were divided as follows (i): Demographics, history, and physical examination; (ii): (i) plus electrocardiography; and (iii): (ii) plus echocardiography, and analyzed by cLR and ML.ResultsIn multivariable analysis via cLR, the AUC and accuracy of the model using the final 20 variables were 0.795 and 72.62%, respectively. In multivariable analysis via ML, the best AUCs in the internal validation were 0.8 with (i), 0.81 with (ii), 0.83 with (iii), and in external validation, the best AUCs were 0.71 with (i), 0.74 with (ii), and 0.79 with (iii). The best AUCs and accuracy of the fittest model including 21 importance variables by ML were 0.81 and 72.48% in internal validation; and 0.75 and 70.5% in external validation, respectively. The importance variables in ML and cLR were similar, but slightly different and the additional discriminators via ML were found.ConclusionThe assessment using the fittest importance variables can assist physicians in differentiating mimicking diseases in which coronary angiography may not be required in patients suspected of having acute coronary syndrome in emergency department.

Diagnostic value of computed tomography myocardial perfusion to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease

Abstract Background The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant epicardial coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of absolute coronary flow by CTP to detect microvascular dysfunction remains unknown. Purpose The aim of study is to assess the diagnostic value of CTP to evaluate coronary microvascular dysfunction (CMD) in patients with significant epicardial coronary stenosis, and to analyze the predicting factors for lesions with CMD. Methods Sixty-eight chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR] &amp;lt;0.80) were investigated. CMD was defined by the index of microcirculatory resistance (IMR) ≥25. Clinical characteristics and CTP findings were compared between the two groups with and without CMD (CMD, n=29, non-CMD, n=39, respectively). The computed tomography angiography (CCTA) assessment included CTP findings and quantitative and qualitative assessment of plaques. Results In wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.59–0.74), 1.71 (1.24–2.88), and 22.6 (15.1–34.5), respectively. In CTP analysis, culprit territory regional absolute myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. CTP-derived CFR (CFRCTP) was calculated as hyperemic-MBF divided by rest-MBF. Rest and hyperemic-MBF and CFRCTP were 0.83 (0.64–1.03) ml/min/g, 2.14 (1.30–2.92) ml/min/g, and 2.19 (1.44–3.37). In the lesions with CMD, hyperemic-MBF was significantly lower than those without CMD (1.68 [0.84–2.44] vs 2.31 [1.67–3.34] ml/min/g, p=0.015) and the prevalence of CFRCTP&amp;lt;2.0 was higher in the lesions with CMD than those without CMD (62.1% vs 28.2%, p=0.007). CCTA analysis showed that fibrofatty and necrotic core component (FFNC) volume was greater in the lesions with CMD than in the lesions without CMD (31.8 [19.0–48.9] vs 25.1 [17.2–32.1] mm3, p=0.045). The multivariable logistic regression analysis, hyperemic-MBF and FFNC volume were independent predictors for lesions with CMD (Odds ratio [OR] 0.583 [0.355–0.958], p=0.033 and OR 1.040 [1.010–1.070], p=0.018). Conclusion Quantitative assessment of absolute coronary flow by CTP and comprehensive plaque analysis by CCTA may help detect coexisting subtended microvascular dysfunction in patients with functionally significant epicardial coronary lesions. Further studies are needed to elucidate the clinical significance of coexisting CMD in CCS patients. Funding Acknowledgement Type of funding sources: None.

Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

Abstract Background Interest grew in residual disease burden after percutaneous coronary intervention (PCI). The residual SYNTAX score (rSS) is a strong prognostic factor of coronary events and all-cause death in patients who underwent PCI. Its derivative, the SYNTAX Revascularisation Index (SRI), has been used in determining the proportion of coronary artery disease (CAD) that has been treated and has been shown to have prognostic utility in PCI for patients with multi-vessel disease (MVD). Purpose We sought to assess the use of the rSS and the SRI as predictors for in-hospital outcomes and up to two-year follow-up outcomes in patients with MVD who underwent PCI in the setting of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI). Methods We recruited 149 patients with either STEMI or NSTEMI in the setting of MVD who underwent PCI. We divided them into tertiles, based on their rSS and SRI values, respectively. We calculated bSS and rSS using the latest version of the web-based calculator, and from these scores we calculated SRI. The endpoints were: In-hospital composite MACE and its components, in-hospital mortality, follow-up MACE, and follow-up all-cause mortality up to 2-years. Results RSS and SRI were not significant predictors of in-hospital death or MACE, while hypertension, ST-segment resolution, LVEF, and significant left main coronary artery (LMCA) lesions were independent predictors of in-hospital MACE. At two-year follow-up, Kaplan-Meier analysis showed significantly increased incidence of death and MACE within the third rSS tertile (rSS &amp;gt;12) compared to the other tertiles (log rank p&amp;lt;0.001), while there was no significant difference between the three SRI tertiles. RSS and SRI were predictors of death and MACE on univariate Cox regression analysis. On multivariate Cox regression, rSS was an independent predictor for MACE (HR=1.0696, 95% CI: 1.0147–1.1275, p=0.0123) and all-cause mortality (HR=1.1114, 95% CI: 1.0430–1.1842, p=0.0011). Of notice, all patients with complete revascularisation survived throughout the entire follow-up period. Conclusions The rSS and SRI were poor predictors of in-hospital death and MACE, while they were good predictors of death and MACE at two-year follow-up, with better overall performance for rSS in comparison to SRI. Patients with rSS values &amp;gt;12 showed significantly higher incidence of MACE and all-cause mortality at two years. The best prognosis was achieved with complete revascularisation. Funding Acknowledgement Type of funding sources: None.

Epidemiology of Kawasaki Disease in children in Switzerland: a national prospective cohort study.

Kawasaki disease is a febrile illness which can lead to significant coronary artery lesions. Its incidence varies among countries and is highest in Japan (330.2 children under 5 years old/100,000 per year). Since the epidemiology of Kawasaki disease in Switzerland is unknown, we conducted a national prospective data collection between 2013 and 2017 to describe its incidence, diagnosis, and treatment. We collected demographic and clinical data of the children under 17 years old hospitalised with Kawasaki disease in Switzerland between March 2013 and February 2017 using anonymous data collection forms with the help of the Swiss Paediatric Surveillance Unit (SPSU). We defined Kawasaki disease per the 2004 American Heart Association criteria: patients with ≥5 days of fever and ≥4 of the 5 main clinical features were included as complete Kawasaki disease and patients with ≥5 days of fever and <4 of the 5 main clinical features were included as incomplete Kawasaki disease. The incidence was calculated with the data of the Federal Statistical Office of Switzerland, considering permanent residents of the country. The different groups were compared by the unpaired student t-test for continuous variables and Pearson's chi squared test for categorical variables, respectively. We included 175 patients: 60% were boys, with a mean age of 38.2 months. The incidence of Kawasaki disease was 3.1/100,000 [95% CI 2.6-3.7] per year in children under 17 years of age and 8.4/100,000 [95% CI 6.7-10.2] per year in children under 5 years of age. The most frequent clinical signs were a rash (85.4%) and changes of the lips and oral/pharyngeal mucosa (83.4%). The diagnosis of Kawasaki disease was made at a mean of 7.3 days after the first symptom. Echocardiography was abnormal in 52.3%. The treatment with intravenous immunoglobulins (IVIG) and acetylsalicylic acid was administered in accordance with international guidelines. Subgroup analysis showed that children older than 5 years old had significantly more complete Kawasaki disease than the younger ones (78.8% vs 57.4%, p = 0.021). Children with "extreme ages" (<1 year old and >8 years old) were diagnosed later (8.6 (±0.9) vs 7.0 (±0.3) days, p = 0.0129), had longer duration of fever (9.8 (±0.9) vs 8.1 (±0.3) days, p = 0.013) and had more echocardiographic abnormalities (n = 26 (70.3%) vs n = 65 (47.5%), p = 0.014) at diagnosis. One child died during the acute phase of the illness. The incidence of Kawasaki disease in Switzerland is in the lower range of other European countries.

Predictive Value of Resting Fractional Flow Reserve and Atherogenic Index of Plasma for Evaluation of Physiologically Significant Coronary Artery Lesions.

This study aimed to assess the relationship between the atherogenic index of plasma (AIP) and resting distal-to-aortic pressure ratio (Pd/Pa) in patients with intermediate coronary artery stenosis. This retrospective study included 802 chronic coronary syndrome patients with intermediate coronary artery stenosis who underwent fractional flow reserve (FFR) measurement. The resting Pd/Pa showed a significant negative correlation with AIP (rho= -.205, p < .001). When final FFR was divided into three tertiles (≤80, 81-89, ≥90), resting Pd/Pa was significantly lower, and AIP was markedly higher in the lower final FFR tertiles (both AIP and resting Pd/Pa differed significantly across the all three tertiles, p < .001). Furthermore, functionally significant stenosis independent predictors in multivariate analyses were AIP and resting Pd/Pa (p = .010 and p < .001, respectively). We observed for the first time an increase in AIP levels in the presence of functionally significant stenoses that may help better planning and identification of those patients with the functionally substantial atherosclerotic burden.

Impact of drug-eluting stent-associated coronary artery spasm on 3-year clinical outcomes: A propensity score matching analysis

BackgroundIt has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina. MethodsA total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n = 108, CAS; n = 1878). For adjustment, propensity score matching (PSM) was done (C-statistics = 0.766, DES-CAS; n = 102, CAS; n = 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data. ResultsBaseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p = 0.012) and ST-T change (10.7% vs. 1.9%, p = 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p = 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p = 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005). ConclusionIn this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.

Análise dos desfechos em intervenção coronária percutânea de tronco de coronária esquerda não protegido

Background: Significant lesions in the left main coronary artery are found in approximately 5% of patients undergoing coronary angiography, with most cases involving multiple vessels and affecting the distal bifurcation. A coronary artery bypass graft surgery is considered the preferred treatment for unprotected left main coronary artery lesions. However, with the advancement of techniques and the introduction of new drug-eluting stents, percutaneous coronary intervention has been considered a viable strategy, with favorable results. The objective of this study was to analyze the outcomes in patients with unprotected left main coronary artery lesions undergoing percutaneous coronary intervention. Methods: Electronic data from patients undergoing percutaneous coronary intervention between December 2017 and January 2020 at a single center were analyzed to assess clinical and angiographic characteristics and clinical outcomes. Results: A total of 103 patients with significant unprotected left main coronary artery lesions were included; in that, 66% were male, 88.3% were hypertensive, and 87.4% had normal ventricular function. Lesions involving the bifurcation were identified in 73.8% of patients, 36.9% had concomitant lesions in the three major epicardial vessels, and 42.7% had an intermediate SYNTAX score (23 to 32 points). Angiographic success was achieved in 100% of cases, with four (3.9%) adverse cardiac and cerebrovascular events, with 2.9% mortality. Conclusion: Hospital results support percutaneous coronary intervention as a safe procedure, with excellent angiographic results and low rates of adverse cardiac and cerebrovascular events. We concluded that PCI is an option to coronary artery bypass graft surgery and is a very viable option for surgical treatment of unprotected left main coronary artery lesions.