Coronary artery disease最新文献

Background: Distal radial access (DRA) is a promising alternative to conventional transradial access for coronary procedures, offering fewer vascular complications, shorter hemostasis, and greater patient comfort. However, the predictors of DRA failure remain insufficiently defined. This study aimed to evaluate the feasibility, safety, and predictors of DRA failure in an all-comer population and to develop an evidence-based strategy to optimize procedural success.

Methods: A prospective multicenter cohort included 1387 patients who underwent 1454 coronary procedures through DRA between August 2020 and September 2024. Multivariate logistic regression and conditional inference trees (CITs) were used to identify and visualize independent predictors of failure.

Results: DRA was successful in 96.5% of cases, with 99% of coronary procedures completed through the initial access. Access-related complications were infrequent (2.5%), including 0.8% inhospital radial artery occlusion. Weak distal radial pulse was the strongest independent predictor of failure (odds ratio: 10.07, 95% confidence interval: 5.22-20.21; P < 0.001), while preprocedural ultrasound (US) evaluation, US-guided puncture, right-sided access, and operator experience independently predicted success. US guidance markedly improved outcomes in patients with weak pulses (98.2% vs. 61.0%; P < 0.001). The learning curve plateaued after 60 cases.

Conclusion: DRA is a safe, feasible, and effective access strategy for coronary procedures in an all-comer population. The success of the procedure depends on the strength of the arterial pulse, the US guidance, and the experience of the operator. The CIT-derived evidence-based framework provides a practical and reproducible approach to optimize access-site selection and improve procedural outcomes.

Intravascular ultrasound (IVUS) or optical frequency domain imaging (OFDI) for guiding percutaneous coronary interventions (PCI) reduces the risk of adverse events compared with angiographic guidance. However, only a few trials compared both modalities. This study aims to assess and compare OFDI- vs. IVUS-guided PCI. We conducted a meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. The primary outcome was major adverse cardiac events (MACE). Risk ratios (RR) were applied for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI). PROSPERO ID: CRD42024595477. Four RCTs with 1135 patients were included. There was no significant difference between the two modalities in terms of MACE [RR: 0.99; 95% CI: (0.53, 1.86); P  = 0.98], all-cause mortality [RR: 0.72; 95% CI: (0.15, 3.56); P  = 0.69], cardiac mortality [RR: 1.00; 95% CI: (0.18, 5.68); P  = 1.00] and myocardial infarction [RR: 1.21; 95% CI: (0.35, 4.18); P  = 0.76]. Additionally, there was no significant difference in PCI success [RR: 1.00; 95% CI: (0.99, 1.02); P  = 0.64]. However, OFDI was associated with a significant increase in contrast volume [MD: 19.81 ml; 95% CI: (2.53, 37.09); P  = 0.02] and reduction in fluoroscopy time [MD: -7.05 min; 95% CI: (-9.32, -4.79); P  < 0.01]. This meta-analysis of RCTs suggests that OFDI is comparable to IVUS in efficacy and safety for guiding PCI, with no significant differences in clinical outcomes. These findings support the use of either modality for PCI guidance. However, additional large-scale, multicenter RCTs to recommended to validate these findings and enhance their generalizability.

Background: Obesity and metabolic disorders are key contributors to the development of atherosclerotic cardiovascular disease (ASCVD). This study sought to investigate the relationship between the newly introduced Metabolic Score for Visceral Fat (METS-VF) and ASCVD, utilizing data from the National Health and Nutrition Examination Survey (NHANES).

Methods: Data from NHANES 2005-2016 were analyzed. Adults with complete METS-VF and ASCVD data were included. Weighted multivariate logistic regression models assessed associations between METS-VF and ASCVD. Smoothed curve fitting and subgroup analyses further explored the relationship. Receiver operating characteristic curves were used to compare the predictive performance of METS-VF with other indicators of visceral fat.

Results: A total of 9979 participants were included, among whom 807 had ASCVD. In the fully adjusted model, each 1-unit increase in METS-VF was associated with a 43% higher ASCVD risk (OR   =  1.43, 95% CI: 1.11-1.85). Compared with Q1, the ORs for Q2, Q3, and Q4 were 1.71, 1.72, and 2.10, respectively ( P for trend <0.05). The curve fitting showed a linear positive association. Subgroup analyses indicated significant associations in men, non-Hispanic Whites and Blacks, and participants without hypertension, who smoked, drank alcohol, or physically inactive. METS-VF showed better predictive ability (AUC  =  0.734) than LAP, VAI, WC, and WHtR.

Conclusions: METS-VF is a reliable, noninvasive, and cost-effective predictor of visceral obesity that demonstrates a linear positive correlation with ASCVD, supporting its use as an accurate measure of ASCVD risk.

Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of death. Although statins are the foundation of lipid-lowering therapy, many high-risk patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets due to intolerance or insufficient response. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as potent agents that address this residual risk. This review summarizes the clinical efficacy, safety, and mechanistic role of PCSK9 inhibitors in cardiovascular risk reduction. Relevant randomized trials, meta-analyses, and observational studies were analyzed, alongside emerging nonstatin therapies including bempedoic acid, inclisiran, and Angiopietin-like 3 inhibitors. PCSK9 inhibitors, such as alirocumab and evolocumab, have shown LDL-C reductions of up to 62% and significant decreases in major adverse cardiovascular events. Trials like Further cardiovascular outcomes research with PCSK9 inhibition in subjects With elevated risk (FOURIER) and Evaluation of cardiovascular outcomes after an acute coronary syndrome during treatment with alirocumab (ODYSSEY OUTCOMES) reported relative risk reductions of 15-24% in select populations. These agents also reduce lipoprotein(a) (Lp(a)) and stabilize atherosclerotic plaques. Additional therapies like inclisiran and bempedoic acid further expand treatment options, particularly for statin-intolerant patients. PCSK9 inhibitors offer a well-tolerated and effective approach to lowering LDL-C and mitigating cardiovascular risk. Their integration, along with emerging therapies, provides a comprehensive strategy to address residual ASCVD risk and improve patient outcomes. This review highlights the pivotal role of PCSK9 inhibitors in achieving significant LDL-C reduction and improving cardiovascular outcomes, especially in high-risk and statin-intolerant populations. By also targeting Lp(a) and promoting plaque stabilization, these agents address multiple contributors to residual ASCVD risk. Incorporating PCSK9 inhibitors and emerging nonstatin therapies into clinical practice offers a powerful strategy to enhance long-term cardiovascular prevention.