Coronary artery disease最新文献

In-stent restenosis (ISR) remains a significant complication of percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease, with potentially severe consequences. This study aimed to evaluate the incidence and predictors of ISR and highlight the role of systematic angiographic follow-up in optimizing patient outcomes. We conducted a retrospective cohort study including 229 patients who underwent LMCA PCI between 2013 and 2023 at ASST Spedali Civili di Brescia. All patients underwent systematic angiographic follow-up at 8 months. Data on clinical, angiographic, and procedural characteristics were collected and analyzed using univariate and multivariate logistic regression to identify predictors of ISR. Kaplan-Meier survival analysis was employed to assess outcomes. ISR was identified in 24 patients (10.5%) during angiographic follow-up, with 29.2% being symptomatic. Chronic kidney disease (CKD; odds ratio: 3.84, P = 0.003) and diabetes (odds ratio: 3.18, P = 0.008) emerged as independent predictors of ISR. Multivariate analysis confirmed these associations. Survival rates were high, with 97.7% at 1 year, 92.2% at 2 years, and 81.5% at 4 years. Subanalyses showed trends toward higher mortality among patients with CKD or diabetes but no significant differences between patients with acute and chronic coronary syndromes. In conclusion, ISR remains a clinically significant challenge after LMCA PCI, with CKD and diabetes as key predictors. Systematic angiographic follow-up is essential for early ISR detection, especially in high-risk populations, as the majority of cases are asymptomatic. These findings emphasize the need for tailored surveillance strategies to improve outcomes.

Background: Myocardial infarction (MI) represents a significant cardiovascular condition that endangers human health. This research aimed to explore the therapeutic effectiveness of sophoricoside (Sop) using a mouse model of MI.

Methods: To conduct this investigation, a mice model of MI was utilized, and Sop was delivered through oral administration via gavage. The area of MI in mice was assessed by Masson trichrome staining. Cardiac systolic function and left ventricular dilatation were measured by cardiac ultrasound. Picrosirius red staining and Masson's trichrome staining were performed to detect the collagen deposition and fibrosis. The expressions of reparative macrophage-associated markers were measured by quantitative real-time PCR. Western blotting was utilized to sense expression of lysyl oxidase (LOX), peroxisome proliferator-activated receptor γ (PPAR-γ), and collagen 1. Flow cytometry was performed to detect the number of macrophages. The Cell Counting Kit-8 assay was performed to detect Sop's cytotoxicity. The M2 polarization and efferocytosis in mice model of MI was verified by immunofluorescence assay.

Results: Sop significantly reduced myocardial infarct size. Cardiac ultrasound evaluation further showed that Sop was effective in improving cardiac systolic dysfunction and left ventricular dilatation. In addition, Sop significantly promoted efferocytosis and reparative M2 macrophage polarization and inhibited glycolytic metabolic pathways, thereby promoting cardiac tissue repair. It was further found that Sop could obviously promote expression of PPAR-γ in the nucleus. GW9662 partially reversed the improvement of Sop on cardiac repair and reparative macrophage polarization in MI mice.

Conclusion: In summary, this study elucidates that Sop enhances reparative macrophage polarization to promote cardiac repair post-MI through PPAR-γ.

Background: Pulse wave velocity (PWV) is considered a more direct and accurate measure of arterial stiffness. This study explored the relationship between PWV and the presence and severity of coronary artery calcification (CAC) and coronary artery plaque (CAP).

Methods: The current study was a cross-sectional analysis of data from the Miami Heart Study (MiHeart). The primary outcome variable of this study was the CAC score. The secondary outcome was the presence of CAC and CAP. Multivariable logistic regression and Bayesian linear regression were used to find the association between PWV CAC and CAP.

Results: A total of 2359 participants were included in the study. The mean age (SD) of the sample was 53.4 (6.8) years and 50.4% were men. Multivariable logistic regression analysis showed that the odds of having CAC greater than 0 was significantly higher with increasing PWV [odds ratio (OR): 1.09, 95% confidence interval (CI): 1.01-1.18]. Similarly, multivariable logistic regression analysis also showed that the odds for CAP were significantly higher with increasing PWV (OR: 1.14, 95% CI: 1.06-1.23). The results of Bayesian linear regression analysis showed that there was a significant association between PWV and log CAC score.

Conclusion: In a large sample of participants from the community and without a history of known cardiovascular disorder, we found that an increase in PWV was associated with the presence of CAC and CAP. In addition, we also found that PWV was associated with severity of CAC as well. Our findings show that PWV could be an important marker of subclinical coronary atherosclerosis in the general population.

Background: Biodegradable polymer drug-eluting stents (BP-DES) are currently used in percutaneous coronary intervention (PCI). Polymer-free drug-eluting stents (PF-DES) have the potential to mitigate any risk associated with BP-DES; however, the relative efficacy and safety of these interventions remain to be fully elucidated.

Methods: A systematic search of PubMed, Embase, and Cochrane Central was performed from inception to January 2025 to identify randomized controlled trials and observational studies comparing PF-DES with BP-DES in patients undergoing PCI. Heterogeneity was assessed using the I² statistic. A two-sided P value less than 0.05 was considered statistically significant. Prespecified subgroup analyses were conducted based on follow-up duration.

Results: A total of seven randomized controlled trials (RCTs) and four observational studies comprising 11 954 patients were included, of whom 5947 (49.7%) received PF-DES. In the pooled analysis, no statistically significant differences were observed between PF-DES and BP-DES in terms of cardiac death [risk ratio: 1.12, 95% confidence interval (CI): 0.96-1.31, P = 0.15], target lesion failure (risk ratio: 1.09, 95% CI: 0.81-1.46, P = 0.58), stent thrombosis (risk ratio: 0.90, 95% CI: 0.58-1.41, P = 0.64), target lesion revascularization (risk ratio: 1.28, 95% CI: 0.81-2.02, P = 0.28), or target vessel revascularization (risk ratio: 1.05, 95% CI: 0.70-1.58, P = 0.79). Likewise, no significant subgroup effect was observed regarding longer-term follow-up outcomes.

Conclusion: This meta-analysis found comparable safety and efficacy outcomes between PF-DES and BP-DES in patients undergoing PCI; however, further RCTs are needed to evaluate long-term outcomes and newer-generation stent models.

Background: Few studies have focused on the association between pan-immune-inflammation value (PIV) and in-hospital heart failure postcoronary angioplasty in elderly patients with acute myocardial infarction (AMI).

Objectives: This prospective study aimed to confirm the relationship between PIV, the severity of coronary artery disease, and in-hospital heart failure in elderly patients with AMI after coronary angioplasty.

Methods: A total of 799 patients with AMI aged greater than or equal to 60 years were enrolled and divided into two groups according to whether they presented heart failure during hospitalization. They all received coronary angiography and underwent successful percutaneous coronary intervention. The degree of stenosis of the coronary artery was assessed with the Gensini score.

Results: PIV was significantly greater in the heart failure group than in the control group (1250 ± 975 vs. 674 ± 406; P < 0.001). The multivariate Cox proportional hazards model analyses found that PIV (hazard ratio: 1.029, 95% confidence interval: 1.015-1.045, P < 0.001) was an independent risk factor of in-hospital heart failure. Receiver-operating characteristic curve analyses showed that the optimal cutoff value of the PIV for pridicting in- hospital heart failure was 693, with a sensitivity of 68% and a specificity of 69%. In addition, the multivariate logistic regression analysis revealed that PIV was an independent predictor of the severity of coronary artery disease (P < 0.05).

Conclusion: PIV was an independent predictor of the severity of coronary artery disease and in-hospital heart failure in elderly patients with AMI after coronary angioplasty.

Objective: Although opioids primarily act on the central nervous system, they also affect the cardiovascular (CV) system. This study aimed to examine the association between long-term opioid use and the risk of CV events in individuals with noncancer pain.

Methods: We conducted a nationwide observational cohort study using data from the Korean National Health Insurance Service, linked to the national health check-up database, between 2009 and 2018. Patients prescribed opioids for ≥90 days were defined as chronic users. After 1:10 propensity score matching, Cox proportional hazards models were used to estimate the risk of myocardial infarction (MI) and ischaemic stroke (IS), reported as hazard ratios (HRs) with 95% confidence intervals (CIs), compared to nonopioid users.

Results: The final analysis included 36 300 opioid users and 334 590 matched controls. Chronic opioid use was significantly associated with increased risk of MI (HR 1.20, 95% CI: 1.12-1.30; P = 0.001) and IS (HR 1.16, 95% CI: 1.12-1.21; P < 0.001). Subgroup analyses indicated that the association between opioid use and CV events varied by factors such as prior major CV diseases, anticoagulant use, area of residence, and gabapentinoid use.

Conclusion: Long-term opioid use in patients with noncancer pain is associated with an increased risk of CV events. These findings underscore the need for careful CV risk assessment when initiating or maintaining chronic opioid treatment.