Coronary artery disease最新文献

Background: Carotid artery stenosis is a significant predictor of perioperative stroke risk in patients undergoing coronary artery bypass grafting (CABG). Identifying noninvasive, simple, and clinically relevant biomarkers for risk stratification is crucial in this population. The CALLY index, a composite marker reflecting systemic inflammation and nutritional status, has shown prognostic value in various diseases. However, its relationship with carotid artery stenosis in patients undergoing isolated CABG remains unclear. This study aimed to evaluate the relationship between carotid artery stenosis and the CALLY index in patients undergoing isolated CABG.

Methods: This retrospective, single-center study included 820 patients who underwent isolated CABG and preoperative carotid Doppler ultrasonography between January 2020 and December 2024. The degree of carotid artery stenosis was classified into three groups (<50, 50-70, >70%). CALLY index values were calculated using lymphocyte count, albumin, and C-reactive protein (CRP) levels. Statistical analyses included Kruskal-Wallis H and Spearman's rank correlation tests.

Results: The CALLY index was significantly lower in patients with higher degrees of carotid artery stenosis ( P  < 0.001). A strong negative correlation was found between the CALLY index and carotid stenosis severity (Spearman's rho = -0.831, P  < 0.001).

Conclusion: Low CALLY index values are significantly associated with the presence and severity of carotid artery stenosis in patients undergoing isolated CABG. The CALLY index may serve as a simple and practical biomarker for preoperative risk assessment, aiding in the identification of high-risk patients and potentially improving surgical outcomes.

Background: Albumin and BMI have been used as nutritional markers of morbidity and mortality. Recently, prealbumin has grown in interest in other surgical disciplines, but less so in cardiac surgery. Thus, this study examined the association between prealbumin and bleeding, mortality, and readmission in coronary artery bypass graft (CABG) patients.

Methods: A retrospective review was performed on all patients undergoing CABG at a single institution from July 2017 to December 2021. Study patients underwent CABG as part of an isolated or combined procedure and had a perioperative prealbumin measurement. The primary study endpoints were intra- and post-operative bleeding, and mortality and hospital readmission within 30 days.

Results: A total of 1211 patients underwent CABG surgery and had a documented perioperative prealbumin. Prealbumin levels were stratified as ≤10, 10-15, 15-20, or >20 mg/dl. There were no differences across prealbumin groups in preoperative antiplatelet use, anticoagulant use, or concomitant procedures. Patients with low prealbumin were more likely to be older, female, and to have an urgent myocardial infarction presentation with lower preoperative BMI and albumin. In adjusted models including albumin and BMI, CABG patients with prealbumin ≤10 mg/dl were more likely to receive any intraoperative [odds ratio (OR) = 3.11, 95% confidence interval (CI): 1.43, 6.75] or postoperative transfusion (OR = 2.54, 95% CI: 1.27, 5.08) compared to patients with prealbumin >20 mg/dl. Patients with a lower prealbumin had higher 30-day mortality ( P  < 0.001) and readmission rates ( P  = 0.06).

Conclusion: Perioperative prealbumin levels were associated with blood transfusions, mortality, and readmissions in CABG patients.

Background: Radial artery occlusion (RAO) is one of the most common complications associated with transradial access in cardiac catheterization procedures. To date there are no standardized protocols, and only a few studies have evaluated the use of anticoagulation for RAO treatment. The current meta-analysis aimed to assess the impact of various anticoagulation strategies on RAO treatment after cardiac catheterization via the transradial route.

Methods: Literature search was performed in PubMed, Web of Science, and CENTRAL databases, from inception until September 2024. The primary outcome of this study was the incidence of radial artery recanalization. The secondary outcomes were the incidence of any bleeding events and symptom resolution during patient follow-up.

Results: A total of six studies with 398 patients were included in the analysis. Patients with RAO under anticoagulation had a sevenfold increased chance of radial artery recanalization [pooled odds ratio (pOR) = 7.36 (3.82-14.17), P < 0.001]. Regarding the symptom persistence, there was no statistically significant difference between patients receiving and not receiving anticoagulation [pOR = 2.61 (0.26-25.86), P = 0.41]. Regarding bleeding events, no pooled data could be extracted; however, no major bleeding events were reported in any study.

Conclusion: This meta-analysis provides compelling evidence that anticoagulation therapy significantly improves radial artery recanalization rates in patients with RAO without increasing the risk of major bleeding events; however, its effect on symptom resolution remains limited, suggesting the need for a comprehensive approach to RAO management.

Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly recognized cause of acute coronary syndromes (ACSs), particularly in young women without traditional atherosclerotic risk factors. While conservative management has become the preferred strategy in most stable patients, the role of antiplatelet therapy in this unique setting remains uncertain. Current clinical practice often extrapolates from ACS guidelines, recommending aspirin monotherapy or dual antiplatelet therapy, despite a paucity of direct evidence. Observational registries have provided conflicting results, with some suggesting a benefit of antiplatelet therapy in reducing recurrent ischemic events, whereas others highlight the potential risks of intramural hematoma propagation and bleeding. This review aims to critically examine the available literature on antiplatelet therapy following conservatively managed SCAD, highlighting mechanistic rationale, guideline perspectives, registry data, and evolving clinical approaches. The discussion emphasizes the need for individualized therapy, the limitations of current evidence, and the urgent requirement for randomized controlled trials to establish optimal antiplatelet strategies in this unique population.

Background: The mechanisms behind lumen reduction after percutaneous coronary intervention with a sirolimus-eluting Magmaris bioresorbable scaffold (MgBRS) are unclear.

Objectives: To identify mechanisms and risk factors for lumen reduction after MgBRS implantation.

Methods: In the OPTIMIS-trial, patients were randomized to predilatation with a scoring balloon or a standard noncompliant balloon before MgBRS implantation. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were performed. Patients were divided into two groups according to minimal lumen area (MLA) at 6-month follow-up: MLA less than or equal to 4 mm 2 and MLA greater than 4 mm 2 assessed with OCT. Matched-framed analysis identified MLA at the lesion site and corresponding sites postprocedure and at follow-up. Vessel injury was defined as an intrascaffold dissection flap greater than or equal to 200 µm. Logistic regression predicted MLA less than or equal to 4 mm 2 .

Results: Preprocedural, postprocedural, and 6-month follow-up IVUS and OCT were analyzable in 73 lesions (MLA ≤ 4 mm 2 , n = 28, and MLA > 4 mm 2 , n =45). In the MLA less than or equal to 4 mm 2 group, lumen area (7.7 ± 1.8-6.4 ± 2.6 mm 2 , P = 0.002) and vessel area (15.5 ± 3.8-14.1 ± 4.4 mm 2 ; P = 0.03) were reduced from postprocedure to follow-up, whereas lumen and vessel area did not differ significantly in the MLA less than or equal to 4 mm 2 group. Vessel injury [odds ratio (OR): 5.1, 95% confidence interval (CI): 1.4-18.8] and predilatation with a standard noncompliant balloon (OR: 4.0, 95% CI: 1.1-14.4) were independent predictors of MLA less than or equal to 4 mm 2 .

Conclusion: Vessel shrinkage was associated with lumen reduction at the lesion site. Vessel injury and lesion preparation with a standard noncompliant balloon were associated with MLA less than or equal to 4 mm 2 .

Background: Timing of invasive coronary angiography in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains controversial. Angiographic risk and, hence, myocardium at risk are not necessarily considered in currently used non-ST elevation myocardial infarction management algorithms. The aim of this study was to assess the diagnostic performance of the SAVE score in NSTE-ACS patients to noninvasively identify patients with high-risk angiographic risk who might benefit from an early invasive strategy.

Methods: We prospectively assessed 950 consecutive patients admitted to five different hospitals with a diagnosis of NSTE-ACS, 598 (491 male, mean age 63 ± 12 years) of whom were risk-stratified according to the SAVE risk score. The primary endpoint was the identification of high-risk angiographic features.

Results: High-risk angiographic features were observed in 347 (58%) (292 male/55 female). SAVE score was significantly higher in patients in the high-risk angiography group compared with patients without high-risk features [6 (4.5-8) ± vs. 4 (2-5.5); P  < 0.001]. Using the proposed risk score, 79% (275 out of 347 patients) were correctly identified as having a high angiographic risk, and 58% (145 out of 251 patients with low-risk angiographic features) were also correctly identified by the SAVE score.

Conclusions: The SAVE score adequately identified patients with high angiographic risk who may benefit from early invasive management strategies.

Background: Early beta-blocker treatment has long been recommended for patients with acute myocardial infarction (AMI), particularly when left ventricular ejection fraction (LVEF) is reduced; however, whether beta-blocker therapy improves outcomes in patients with AMI receiving contemporary treatment remains uncertain. This study aimed to investigate temporal trends in the effect of beta-blocker therapy on outcomes of patients with AMI in a large, nationwide cohort.

Methods: Patients with AMI enrolled in the Acute Coronary Syndromes Israeli Survey from 2000 to 2021 were included. They were categorized into three periods: early (2000-2004), mid (2006-2016), and late (2018-2021). Each period group was further divided into two subgroups based on LVEF (>40 and ≤40%) and then stratified by beta-blocker treatment status.

Results: The cohort consisted of 11 569 patients. Among patients with LVEF less than 40%, beta-blocker treatment was associated with improved 1-year survival rates in the early (9.1 vs. 20.4%; P < 0.001) and mid (10 vs. 20.6%; P < 0.001) periods only. Among patients with LVEF greater than or equal to 40%, beta-blocker treatment was linked to enhanced 1-year survival in patients enrolled in the early period (3.4 vs. 7.6%; P < 0.001), but not in the mid and late periods.

Conclusion: The association between beta-blocker treatment and improved survival in patients with AMI has diminished over recent decades, regardless of LVEF. These findings are likely attributed to the advancements in contemporary medical and revascularization therapy. As such, our results may challenge current recommendations regarding beta-blocker therapy in AMI.