Coronary artery disease最新文献

Background: Obstructive sleep apnea (OSA) is a risk factor for coronary artery disease (CAD), while endothelial progenitor cells (EPCs) are critical for vascular repair. This study investigated the associations among OSA-related hypoxemia, circulating EPC, and CAD severity.

Methods: This prospective study enrolled patients with unstable angina undergoing coronary angiography. All participants underwent overnight polysomnography to determine the apnea-hypopnea index (AHI) and the sleep apnea-specific hypoxic burden (SASHB). Circulating EPCs were quantified using flow cytometry. CAD severity was assessed via angiography, with a Gensini score greater than or equal to 22 defining severe CAD and the presence of greater than or equal to 2 major vessels with greater than or equal to 50% diameter stenosis defining multivessel CAD.

Results: Among 80 included patients [median age 59 years; 53 (66.3%) male], 42 (52.5%) had OSA (AHI ≥ 15 events/h). Patients with high SASHB exhibited more severe coronary artery lesions than those with low SASHB (Gensini: 33.0 vs. 19.5; P = 0.040). Multivariable linear regression confirmed log10-transformed SASHB as an independent predictor of reduced circulating EPC levels (count: standardized β = -0.37, P = 0.002; percentage: standardized β = -0.40, P < 0.001). Multivariable logistic regression analysis revealed low EPC count [odds ratio (OR) = 3.41, 95% confidence interval (CI): 1.21-9.58, P = 0.020] and low EPC percentage (OR = 2.94, 95% CI: 1.00-8.78, P = 0.049) as independent risk factors for multivessel CAD.

Conclusion: OSA may promote CAD progression by depleting EPCs and hindering vascular repair. Incorporating hypoxemia metrics and EPC levels into risk assessment could help identify patients with OSA-related CAD.

Background: Premature acute myocardial infarction (AMI) is increasingly prevalent yet underrepresented in trials. We aimed to evaluate the prognosis of premature AMI and the prognostic impact of multivessel coronary artery disease.

Methods: We analyzed consecutive AMI patients undergoing percutaneous coronary intervention in the multicenter Cardiovascular Risk and Identification of Potential High-Risk Population in AMI registry between April 2001 and April 2015, with follow-up through October 2019. Patients with premature AMI (age ≤ 45 years) were analyzed, and those who experienced in-hospital death were excluded. The primary outcome was major adverse cardiovascular events (MACE, a composite of recurrent myocardial infarction (MI), stroke, or repeat revascularization). Risks of ischemic outcomes were evaluated using multivariable Fine-Gray subdistribution hazard models. Sensitivity analyses included cause-specific Cox regression and multiple-imputation Cox models, accounting for competing risks.

Results: Of the 10 144 AMI patients, 907 (8.9%) had premature AMI (mean 40.4 years; 94.3% male). Compared with older patients, premature AMI was not associated with lower risk of MACE [adjusted subdistribution hazard ratio (sHR) 1.01, 95% confidence interval (CI): 0.84-1.21], recurrent MI (adjusted sHR 1.49, CI: 1.07-2.06), and repeat revascularization (adjusted sHR 1.16, 95% CI: 0.95-1.44), despite fewer comorbidities. Findings were consistent across sensitivity analyses. In premature AMI, 34.3% had multivessel disease, which independently predicted higher risks of MACE (sHR 2.46), recurrent MI (sHR 3.34), and repeat revascularization (sHR 2.46) compared with older patients (sHR 1.47, 1.22, 1.61, respectively) with significant age-by-multivessel interactions.

Conclusion: Premature AMI exhibited sustained long-term ischemic risk despite favorable baseline profiles. Multivessel disease conferred a greater prognostic impact in younger patients, highlighting the need for intensified secondary prevention strategies. Given the extended inclusion period encompassing major therapeutic advances, these findings should be interpreted with caution and warrant validation in contemporary clinical practice.Registration: https://www.clinicaltrials.gov; unique identifier: NCT02806102.

Introduction: Coronary stenosis with severe calcification is a serious challenge for percutaneous coronary intervention. Coronary artery calcification interferes with stent expansion and catheter passage and leads to higher complications, such as target lesion failure, stent thrombosis, and cardiac mortality. There are multiple proposed modalities for calcium modification, such as intravascular lithotripsy (IVL) and rotational atherectomy. We aim to compare both techniques for calcified coronary artery disease.

Methods: We systematically searched PubMed, Scopus, Cochrane, and Web of Science from inception to January 2025. To estimate the effect size, dichotomous outcomes were pooled as odds ratio (OR), and continuous outcome was pooled as mean difference with their respective 95% confidence interval (CI). The prespecified primary endpoint was major adverse cardiovascular events (MACE; in‑hospital and longest reported follow‑up). Procedural success was a prespecified key secondary endpoint.

Results: Fifteen studies were included (rotational atherectomy: n = 1406; IVL: n = 1088). There was no difference in MACE in‑hospital (OR = 1.43, 95% CI: 0.63-3.22) or at longest follow‑up (OR = 0.93, 95% CI: 0.44-2.00). Procedural success favored IVL (OR = 0.57, 95% CI: 0.36-0.89). Safety endpoints favored IVL: rotational atherectomy was associated with more coronary perforation (OR = 2.67, 95% CI: 1.58-4.49) and slow flow/no‑reflow (OR = 2.49, 95% CI: 1.03-6.03). There were no differences in mortality (in‑hospital or long‑term), myocardial infarction (in‑hospital or long‑term), target vessel revascularization, or stent thrombosis. Procedure duration was shorter with IVL (mean difference: 13.79 min, 95% CI: 4.09-23.49).

Conclusion: IVL and rotational atherectomy are excellent options to be utilized in the plaque modification of calcified coronary artery lesions before drug-eluting stents implantation with comparable clinical safety and efficacy outcomes. Rotational atherectomy and IVL yielded comparable clinical outcomes for MACE. IVL was associated with higher procedural success, fewer periprocedural complications (perforation, slow flow/no‑reflow), and shorter procedures. However, the higher costs incurred by IVL represent a major drawback that limits the use and the standardization of such a technique in clinical practice.

Background: The left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis is standard in coronary artery bypass grafting (CABG) owing to its long-term patency. However, in hemodialysis patients with an ipsilateral upper-limb arteriovenous fistula (AVF), in-situ LITA grafting may raise concern for coronary steal syndrome (CSS). We assessed whether AVF laterality influences outcomes after CABG with LITA-LAD in hemodialysis patients.

Methods: We retrospectively reviewed hemodialysis patients who underwent isolated primary CABG with in-situ LITA-LAD between 2002 and 2020. Patients were classified by AVF side (ipsilateral vs. contralateral). The primary endpoint was all-cause mortality; secondary endpoints were cardiac death, major adverse cardiac events (MACEs), and in-hospital mortality. Propensity score matching (2 : 1), time-to-event analyses, and competing-risk analyses were performed.

Results: Of 206 patients (169 ipsilateral and 37 contralateral), 99 (66 ipsilateral and 33 contralateral) were matched, achieving covariate balance. All-cause mortality was similar in the overall and matched cohorts (log-rank P = 0.89 and P = 0.34), and AVF laterality was not associated with mortality (hazard ratio: 0.98, 95% confidence interval: 0.57-1.69, P = 0.94). Cardiac death, MACEs, and in-hospital mortality did not differ significantly; all four in-hospital deaths occurred in the ipsilateral group (three due to cardiac causes).

Conclusion: In hemodialysis patients undergoing CABG with in-situ LITA-LAD, an ipsilateral AVF was not associated with worse survival or cardiovascular outcomes, supporting the safety of in-situ LITA grafting even when ipsilateral to an AVF. Future studies should identify CSS high-risk subgroups (e.g. subclavian artery stenosis, forearm vs. upper-arm AVF).

Background: Cancer survivors have an elevated cardiovascular disease burden, yet the influence of cancer history on coronary calcification and outcomes following percutaneous coronary intervention (PCI) is not well characterized. This study investigated the association between cancer history and coronary calcification assessed by intravascular ultrasound (IVUS), and examined outcomes after IVUS-guided PCI.

Methods: We retrospectively evaluated 450 patients with stable angina who underwent IVUS-guided PCI between January 2020 and March 2024 and stratified them into cancer (n = 110) and non-cancer (n = 340) groups. Coronary calcification was graded using an IVUS-derived calcium score. Major adverse cardiac and cerebrovascular events (MACCEs) were assessed during follow-up. Multivariate logistic and Cox regression analyses identified predictors of severe calcification (IVUS-calcium score ≥2) and MACCEs excluding cancer-related deaths. Furthermore, outcomes of rotational atherectomy for severely calcified lesions were examined.

Results: Patients with a history of cancer had a high prevalence of moderate-to-severe calcification. Cancer history was independently associated with severe calcification (adjusted odds ratio: 2.32; 95% confidence interval: 1.43-3.77; P < 0.001), but not with MACCEs excluding cancer-related deaths. An IVUS-calcium score ≥2 and impaired renal function were independently associated with MACCEs excluding cancer-related deaths. Among patients undergoing rotational atherectomy, clinical outcomes including MACCEs and target lesion revascularization were comparable between groups.

Conclusion: Cancer history was associated with a greater coronary calcification burden; however, clinical outcomes following IVUS-guided PCI showed no significant difference between patients with and without cancer. These findings suggest that appropriate IVUS-guided lesion assessment enable safe revascularization in this high-risk population.