Coronary artery disease最新文献

Background: The benefits of revascularization in patients with chronic total occlusion (CTO) and reduced left ventricular ejection fraction (LVEF) remain controversial.

Purpose: This study aimed to investigate the clinical impact of CTO revascularization in patients with reduced LVEF compared with those receiving medical treatment (MT).

Methods: In total, 369 consecutive patients diagnosed with CTO by coronary angiography were allocated to either the MT group ( n  = 204) or the percutaneous coronary intervention (PCI, n  = 165) group according to the treatment strategy. The 5-year clinical outcomes were compared between the two groups using a Cox proportional hazards model.

Results: After inverse probability treatment weighting analysis, the pseudo-sample sizes in the MT and PCI groups were 364 and 370, respectively. After a median 6-year follow-up period (interquartile range, 5.0-8.1 years), the incidence of cardiac death was higher in the MT and PCI groups, at 9.0 and 4.5%, respectively ( P  = 0.019). Cardiac death following heart failure hospitalization occurred in 3.8 and 1.0%, respectively ( P  = 0.017). In contrast, target vessel revascularization for CTO lesions was more frequent in the PCI group than in the MT group (11.5 and 22.7%, respectively, P  < 0.001). In the inverse probability treatment weighting population, patients undergoing CTO revascularization had survival benefits for cardiac death [hazard ratio: 0.48 (95% CI, 0.26-0.88)] and cardiac death after heart failure hospitalization [hazard ratio: 0.27 (95% CI, 0.08-0.84)].

Conclusion: In patients with LV systolic dysfunction, particularly those with EF less than or equal to 40%, successful CTO revascularization is associated with long-term survival benefits. These results suggest that successful CTO revascularization is associated with reduced rates of cardiac death and death after hospitalization for heart failure.

Background: There is emerging evidence that plaque features may play a critical role in future acute coronary syndrome. In this study, we analyzed plaque features using an artificial intelligence-enabled algorithm in a clinical cohort who developed non-ST-elevation myocardial infarction (NSTEMI) following coronary CT angiogram (CCTA).

Methods: We performed a case-control study selected from 13 751 consecutive cases in a single center referred for outpatient CCTA. After a follow-up of 4.3 ± 4 years, 48 patients without preexisting coronary disease developed NSTEMI. Controls (N = 187) were matched to the cases on age, gender, BMI, and kilovoltage for CTA acquisition. Quantitative plaque analysis was performed using artificial intelligence-enabled Autoplaque software (Autoplaque version 3.0; Cedars-Sinai Medical Center, Los Angeles, California, USA). Multivariable Cox proportional hazards models were performed to identify the predictors of NSTEMI.

Results: The mean age was 64 ± 11 years. Both case and control groups had mild stenosis at baseline (26 vs 17%, P = 0.01). The total calcified plaque and fibrous plaque volume were not different (P = 0.10 and P = 0.13, respectively). Necrotic core plaque volume and fibrous fatty plaque volume were higher in the NSTEMI group (28 ± 29 vs 9 ± 13 mm3, 169 ± 157 vs 84 ± 105 mm3, respectively, both P < 0.01). In multivariable Cox regression, necrotic core volume portended the greatest risk of NSTEMI, a seven-fold higher than that of total plaque volume.

Conclusion: Using artificial intelligence-enabled plaque analysis, noncalcified plaque volume, especially necrotic core and fibrous fatty plaque volume are important precursors for future NSTEMI events.

Background: This multicenter observational study aimed to retrospectively evaluate the mid-term clinical outcomes of the mini-crush technique (MCT) and double kissing culotte technique (DKCT) in patients with coronary bifurcation lesions (CBLs).

Methods: This large-scale, multicenter study ( n  = 8) included patients with CBLs who underwent percutaneous coronary intervention with either MCT or DKCT. The primary endpoint was defined as major adverse cardiac events (MACE), which include cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization.

Results: A total of 728 patients [male: 584 (80.2%), mean age: 60.93 ± 10.46 years] were included. The initial revascularization strategy was MCT in 476 (65.4%) cases and DKCT in 252 (34.6%) cases. The number of balloons used (6.30 ± 1.84 vs. 5.43 ± 1.99, P  < 0.001) and procedure time (65.10 ± 20.34 vs. 61.30 ± 18.48 min, P  = 0.020) were significantly higher in the DKCT group. In multivariate Cox regression analysis, risk-adjusted mid-term MACE [hazard ratio (HR): 0.645, (95% confidence interval: 0.395-1.053), P  = 0.079] did not differ in the MCT group compared to the DKCT group. Additionally, chronic kidney disease (HR = 2.434, P  < 0.001), high SYNTAX score (HR = 1.085, P  < 0.001), final kissing balloon inflation (HR = 0.110, P  < 0.001), presence of nonfatal intraprocedural complications (HR = 5.818, P  < 0.001), and high total cholesterol level (HR = 1.007, P  = 0.005) were found to be independent predictors of MACE.

Conclusion: This multicenter registry demonstrates that in patients with CBLs, the risk-adjusted MACE rate was similar between both techniques, with a nonsignificant trend favoring MCT at mid-term follow-up.

Background: Moderately elevated serum bilirubin levels and aerobic exercise effectively reduce the risk of coronary artery disease (CAD). However, the relationships among aerobic exercise, total serum bilirubin (TSB), and inflammation remain unclear. We investigated the associations among aerobic exercise, TSB, and inflammatory response, with TSB as a mediator of this association.

Methods: This cross-sectional study included 8290 participants registered at the Health Planning Center of Nihon University Hospital in 2019. We defined aerobic exercise as 30 min of sweating at least twice a week for over a year.

Results: In this cohort (average age, 46.7 ± 13.0 years; 59% men), participants who undertook habitual aerobic exercise ( n  = 2131) had significantly higher TSB levels [0.78 (0.91/0.99) mg/dl vs. 0.74 (0.58/0.95) mg/dl, P  < 0.0001] than those who did not ( n  = 6159). Multivariable logistic regression analysis demonstrated that aerobic exercise independently predicted higher TSB levels (>50 th percentile set as the dependent variable). Participants with habitual aerobic exercise had significantly lower inflammatory blood cell components, including leukocyte, neutrophil, and platelet counts, than those who did not (all P  < 0.0001). The levels of these inflammatory markers significantly decreased with increasing TSB levels. Mediation analysis indicated that higher TSB levels partially mediated the association between aerobic exercise and lower counts of inflammatory markers.

Conclusion: Habitual aerobic exercise was associated with lower levels of inflammatory markers and higher TSB levels, which mediated the anti-inflammatory effects of aerobic exercise. These associations potentially elucidate the preventive effects of aerobic exercise on CAD risk.

Background: Artificial intelligence (AI) augmentation of ECG assessment has significant potential to improve patient outcomes in acute coronary syndrome.

Objective: We sought to evaluate the performance of a novel AI device (PMCardio) in assessing angiographic occlusion myocardial infarction (OMI) and predicting clinical outcomes.

Methods: We used a 1-year retrospective cohort of angiographic data from patients presenting with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). The device analyzed precatheterization ECGs to identify OMI, defined as a culprit vessel with thrombolysis In myocardial infarction (TIMI) 0-2 flow or TIMI 3 flow and peak cardiac troponin I > 10.0 ng/ml.

Results: A total of 217 patients were included: 72 STEMI (32%) and 145 NSTEMI (65%). Angiographic OMI was confirmed in 60 (83%) STEMI and 51 (35%) NSTEMI cases. The AI model achieved a sensitivity of 86.5%, specificity of 82.2%, and an area under the curve of 0.84. Traditional STEMI criteria had a sensitivity of 54.1% and a specificity of 88.7%. The AI model was 100% sensitive in detecting STEMI-OMI. The odds ratio for mortality in AI-detected OMI patients was 12.44 (1.56-98.98), unplanned readmissions 1.15 (0.53-2.51), and reduced ejection fraction at 1 year 0.24 (0.26-2.16).

Conclusions: The AI model demonstrated higher sensitivity and similar specificity compared with traditional STEMI criteria, improving OMI detection while reducing false positives. These findings suggest potential benefits in triage accuracy and resource utilization, but further prospective validation is needed to determine its clinical impact.