Coronary artery disease最新文献

Background: Current guidelines recommend an early invasive coronary angiography (ICA) within 24 h of admission for high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Nevertheless, meta-analyses failed to demonstrate a clear advantage of this strategy in reducing hard endpoints such as death or nonfatal myocardial infarction compared to a delayed approach. Thus, the optimal timing of ICA in high-risk NSTE-ACS remains undetermined.

Objective: This study aimed to determine the optimal timing for ICA in high-risk NSTE-ACS, regarding 1-year all-cause mortality and cardiovascular rehospitalizations.

Methods: We conducted a national multicenter retrospective study of high-risk NSTE-ACS patients included in the Portuguese Registry for Acute Coronary Syndromes. Patients were divided into three groups according to the time of ICA: within the first 24 h, between 24 and 48 h, and between 48 and 72 h. The incidence of in-hospital complications and mortality, 1-year mortality, and cardiovascular rehospitalizations were assessed.

Results: Of the 9949 patients included, 46.7% underwent early ICA. This was associated with a lower incidence of acute heart failure (8.5% vs. 11.1% vs. 11.5%, P  < 0.001) and shorter length of stay (3 vs. 4 vs. 6 days, P  = 0.012). It, however, did not reduce in-hospital complications or mortality (1.2 vs. 0.7 vs. 0.8%, P  = 0.066). We also found no significant association with the composite endpoint of 1-year mortality or cardiovascular rehospitalization (15.1 vs. 15.9 vs. 15.7%, P  = 0.887).

Conclusions: Early ICA was associated with a lower incidence of acute heart failure and shorter length of stay, without a significant impact on 1-year mortality risk or cardiovascular rehospitalizations.

Background: The fibrosis-4 (FIB4) index, a simple, noninvasive marker used for hepatic diseases, represents adverse outcomes. The aim of the present study was to evaluate whether the FIB4 index can predict adverse outcomes in patients with ST-elevation myocardial infarction (STEMI).

Methods: We investigated patients with STEMI who underwent primary percutaneous coronary intervention (PCI) and were alive at discharge. The cut-off FIB4 index at discharge was investigated using the survival classification and regression tree (CART) model to predict adverse outcomes. The primary outcome was all-cause mortality.

Results: Between January 2006 and December 2018, 1354 patients with STEMI (median age, 68 years; men, 76.1%) were investigated. The median value of the FIB4 index was 1.21 (0.84-1.78). The CART model divided the study population into low (FIB4 index <0.945; n  = 435), intermediate (0.945 ≤ FIB4 index < 2.185; n  = 692), and high (FIB4 index ≥2.185; n  = 227) groups based on the significant predictive values for all-cause death. During a median follow-up period of 4.3 years, all-cause death occurred in 208 patients (15.4%). The Kaplan-Meier analysis showed a significant increase in mortality with higher FIB4 index values (log-rank, P  < 0.001). The multivariate Cox regression model revealed that the FIB4 index was an independent risk predictor for all-cause death in patients with STEMI [low group as reference vs. intermediate group, hazard ratio: 1.975; 95% confidence interval (CI): 1.166-3.346; P  = 0.011 and vs. high group, hazard ratio: 4.633; 95% CI: 2.549-8.418; P  < 0.001].

Conclusions: The FIB4 index was associated with the risk of all-cause mortality in patients with STEMI who underwent primary PCI.

Objective: Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions.

Methods: This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People's Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model.

Results: The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan-Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23-0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17-0.76; P < 0.01) for the PSM-adjusted model.

Conclusion: Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.

Background: Chronic total occlusions (CTOs) of coronary arteries present a significant challenge in cardiology, with long-term outcomes following percutaneous coronary intervention (PCI) for CTOs remaining variable and unpredictable. The Naples prognostic score (NPS), which incorporates markers of nutritional status and systemic inflammation, has shown potential in predicting outcomes in various cardiovascular settings. This study evaluates the NPS as a predictor of long-term outcomes after PCI for CTOs.

Methods: A retrospective analysis was conducted on 287 patients who underwent coronary angiography. Patients were categorized into non-CTO-PCI and CTO-PCI groups. Patients were further stratified based on survival status. Cox regression and Kaplan-Meier survival analyses were used to evaluate the association between NPS and long-term outcomes.

Results: The mean age of the study population was 63.5 ± 10.6 years, with 28.6% being female. The NPS was significantly higher in the CTO-PCI group compared to the non-CTO-PCI group ( P = 0.004) and was also elevated in the non-survival group ( P = 0.004). Multivariable Cox regression analysis identified NPS as an independent predictor of mortality ( P = 0.015). Kaplan-Meier analysis demonstrated significantly higher mortality in patients with an elevated NPS ( P = 0.009).

Conclusion: The NPS is a valuable independent predictor of long-term mortality in patients undergoing CTO-PCI. Incorporating NPS into existing risk stratification models could improve predictive accuracy and guide individualized patient management. Further prospective studies are warranted to validate these findings and explore interventions targeting inflammation and nutrition in this high-risk population.

Background: Coronary artery calcium, a marker of coronary atherosclerosis, is often identified on noncoronary chest computed tomography (CT). We wanted to evaluate the correlation between the presence of coronary plaques in coronary artery catheterization and coronary calcifications as shown in noncardiac chest CT.

Methods: A retrospective case-control study consisting of cases (N = 63) and controls (N = 29), aged 18-70 years old, residing in northern Israel and treated in the Intensive Cardiac Care Unit of Ziv Medical Center, between January 2020 and November 2022. All participants underwent coronary catheterization and noncoronary CT scans in the 5 years before the catheterization procedure. Data were taken from the participants' electronic files while considering the potential of cardiovascular risk factors.

Results: The 92 participants had a mean age of 60.1 ± 10.3 years old. Multivariate logistic regression adjusted to age, sex, and hyperlipidemia showed that calcified coronary artery as shown on a previous noncardiac CT scan was positively and significantly associated with increasing risk of coronary plaque as presented in coronary catheterization: odds ratio = 5.93 (95% confidence interval: 1.85-19.07, P < 0.01) and was also associated with male sex who were more likely to have plaque on coronary catheterization than females: odds ratio = 3.77 (95% confidence interval: 1.29-11.32, P < 0.05).

Conclusion: Coronary calcifications on a previous noncoronary CT scan and sex are positively and significantly associated with coronary plaque risk as present in coronary catheterization. Coronary evaluation on CT scans is important for early detection of coronary disease. Early treatment can avoid coronary disease complications and increase patient survival.

Objective: Coronary artery calcium (CAC) scoring may be a useful tool for assessing cardiovascular disease in young adults, particularly in those with risk factors such as hypertension, dyslipidemia, or smoking. In this study, we aimed to address the risk factors for developing noncalcified plaque in young adults by assessing total plaque burden.

Methods: A single-center retrospective cohort study was conducted among 1026 consecutive patients aged 18-45 years who underwent CAC scoring and coronary computed tomography (CT) angiograms for clinical indications. CAC scores and total plaque scores (TPS) were calculated using standard scoring protocols. Multiple logistic regression analysis was conducted to identify independent risk factors of significant, noncalcified plaque in subjects where CAC = 0.

Results: This single-center retrospective cohort study included 1026 patients aged 18-45 years who underwent CAC scoring and coronary CT angiograms for clinical indications. The mean age of the population was 38.8 years old. Sixty-three patients had a CAC score of 0 and a TPS >0. Of the patients with noncalcified plaque burden, 15% had a stenosis >50%, and 10% had a stenosis >70%. The odds of a subject having noncalcified plaque presence and CAC absent were significantly associated with being Hispanic, having diabetes, and having hyperlipidemia.

Conclusion: In young adults aged 18-45 years old, we found diabetes, hyperlipidemia, and being of Hispanic origin to be significantly associated with noncalcified plaque burden.