Coronary artery disease最新文献

Objective: C-reactive protein and uric acid to albumin ratio (CUAR) is a recent inflammatory marker associated with cardiovascular disease. We aim to investigate the relationship between CUAR and coronary collateral circulation (CCC) in patients with stable coronary artery disease and chronic total occlusion (CTO).

Methods: The patients were divided into two groups; 267 patients with poor CCC formation group and 133 patients with well CCC formation group. CUAR log was calculated using the 'log10 (CRP × UA/Albumin)' formula.

Results: CUAR log levels were significantly higher in patients with poor CCC formation ( P  < 0.001). CUAR log levels above 1.45 predicted poor CCC with a higher sensitivity of 70% and specificity of 67% than uric acid to albumin ratio (UAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) ( P  < 0.001). In the comparison of the AUC values, there was a significant difference between the CUAR log and UAR ( P  = 0.047), NLR ( P  = 0.001), and PLR ( P  < 0.001). In multivariate regression analysis, CUAR log above 1.45 ( P  < 0.001) was associated independently with poor CCC occurrence.

Conclusion: Our results suggested that CUAR log is a more potent and independent marker than other inflammatory markers to predict poor CCC occurrence in CTO patients. It may be useful to identify high-risk patients with poor CCC occurrence.

Background: Vessel fractional flow reserve (vFFR) is an angiography-based assessment for coronary physiology. vFFR can be measured at baseline and after percutaneous coronary intervention (PCI). Residual vFFR, a feature designed to predict post-PCI vFFR following stent implantation, can be utilized for PCI planning. This study aimed to investigate the correlation between residual vFFR and post-PCI vFFR, and to identify factors associated with achieving post-PCI vFFR greater than or equal to 0.90.

Methods: Between July 2017 to December 2022, 143 chronic coronary syndrome patients (222 vessels) undergoing image-guided PCI using second-generation drug-eluting stents were analyzed retrospectively. Pre-PCI vFFR, residual vFFR, and post-PCI vFFR were calculated using coronary angiograms obtained before and after PCI.

Results: Residual vFFR showed a moderate correlation with post-PCI vFFR ( r  = 0.65, P  < 0.001) and had a good predictive value for post-PCI vFFR greater than or equal to 0.90 (area under the curve: 0.83, 95% confidence interval: 0.76-0.90). Multivariable logistic regression analysis indicated non-left anterior descending (LAD) lesions (odds ratio: 4.30, 95% confidence interval: 1.76-10.49; P  = 0.001) and stent size greater than or equal to 3.0 mm (odds ratio: 4.23, 95% confidence interval: 1.83-9.74; P  < 0.001) were associated with optimal post-PCI vFFR.

Conclusion: Residual vFFR demonstrated a strong predictive value for achieving post-PCI vFFR greater than or equal to 0.90. Non-LAD lesions and stent sizes greater than or equal to 3 mm were associated with achieving optimal physiological outcomes after PCI.

Radiation therapy for breast cancer increases the risk of coronary artery disease by promoting atherosclerotic plaques. However, the extent of changes in coronary artery calcification (CAC) scores postradiation and the influencing factors remain unclear. This systematic review and meta-analysis evaluated studies investigating changes in CAC scores following breast cancer radiation therapy. Data abstraction was independently performed by two unblinded reviewers using structured collection forms, with no divergences in data collection. The nine-star Newcastle-Ottawa Scale scoring system assessed methodological quality. Statistical analysis was conducted using Comprehensive Meta-Analysis software. Among eight studies (1972 patients), radiation doses ranged from 47 to 60 Grays. The overall rate of CAC score increase or new appearance postradiation was 25.8% [95% confidence interval (CI), 21.3-30.8%]. The rate was significantly higher after left-sided radiation at 32.3% (95% CI, 25.7-39.6%) compared to 16.1% (95% CI, 5.8-37.3%) for right-sided radiation. CAC score development occurs in approximately one-quarter of breast cancer patients after radiation therapy, with a significantly higher risk following left-sided radiation. These findings underscore the need for tailored monitoring strategies to mitigate cardiovascular risks in this population.

Background: Renin-angiotensin system inhibitors (RASi), including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, improve outcomes after acute myocardial infarction. However, in the drug-eluting stent (DES) era with routine percutaneous coronary intervention (PCI), the duration and timing of benefit after ST-elevation myocardial infarction (STEMI) remain uncertain.

Methods: Using the nationwide prospective Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry, we identified STEMI patients who underwent successful DES-PCI and survived to discharge (n = 5017). RASi exposure was defined at discharge for analyses from 0 to 12 months and reassigned at a 12-month landmark for analyses from 12 to 36 months, reflecting real-world switching or discontinuation. The primary outcome was all-cause mortality. Confounding was addressed using 1 : 1 propensity-score matching (851 pairs) and Cox proportional hazards models.

Results: At discharge, 4093 patients received RASi and 924 did not. At 12 months, all-cause mortality was lower with RASi in the overall cohort [2.1 vs. 4.5%, hazard ratio: 0.45, 95% confidence interval (CI): 0.31-0.66, P < 0.001] and matched cohort (3.0 vs. 4.9%, hazard ratio: 0.61, 95% CI: 0.37-1.00, P = 0.050), driven by fewer cardiac deaths. Over 36 months, RASi was associated with lower mortality overall and after matching. From 12 to 36 months, landmark analyses showed neutral associations. First-year left ventricular ejection fraction and blood pressure improved more with RASi (both P < 0.01).

Conclusion: In STEMI treated with DES-PCI, RASi at discharge offers a survival benefit concentrated within the first year. After 12 months, associations were neutral among event-free survivors, supporting early initiation and maintenance of RAS inhibition with individualized reassessment beyond 1 year.

Background: Balloon-expandable valve (BEV) and self-expanding valve (SEV) are used in transcatheter aortic valve replacement (TAVR). Patients with a small aortic annulus (SAA) make up to one-third of the cases and face higher risks of prosthesis-patient mismatch and high valvular gradients.

Objectives: This meta-analysis aimed to compare balloon-expandable and self-expanding valves used in TAVR in patients with a SAA, focusing on hemodynamic and clinical outcomes.

Methods: We systematically searched Cochrane Central, PubMed, and EMBASE for studies comparing balloon-expandable and self-expanding valves in patients with SAA undergoing TAVR. Random effects models were applied to generate odds ratios (ORs) and mean differences with 95% confidence interval (CI).

Results: Fifteen studies (two randomized controlled trials and 13 propensity-matched studies) with 5149 patients (48.4% balloon-expandable valves) were identified. BEVs were associated with a lower indexed effective orifice area (mean difference: -0.18, 95% CI: -0.25 to -0.10; P < 0.00001) and higher transvalvular mean pressure gradient (mean difference: 4.32, 95% CI: 3.39-5.24; P < 0.00001) and peak pressure gradients (mean difference: 4.87, 95% CI: 1.23-8.51; P = 0.009). Permanent pacemaker implantation (OR: 0.57, 95% CI: 0.44-0.73; P < 0.0001) and major bleeding (OR: 0.67, 95% CI: 0.47-0.96; P = 0.03) were lower in balloon-expandable valves. BEVs increased the odds of any prosthesis-patient mismatch (OR: 2.28, 95% CI: 1.61-3.22; P < 0.00001) and severe prosthesis-patient mismatch (OR: 3.16, 95% CI: 2.19-4.58; P < 0.00001).

Conclusion: In patients with SAA undergoing TAVR, SEVs offer superior hemodynamic performance, whereas BEVs are associated with fewer conduction disturbances and bleeding events. Both valve platforms yielded similar clinical outcomes, underscoring the need for individualized device selection.