Coronary artery disease最新文献

Background: Photon-counting detector computed tomography (PCD-CT) is an emerging technology that improves dose efficiency, image resolution, and noise performance. We aimed to compare the safety and effectiveness of the first-generation PCD-CT with a third-generation energy-integrating detector computed tomography (EID-CT) for the detection of coronary artery disease in the participants from a health check programme in Taiwan.

Methods: In this retrospective, single-centre study, we included 205 asymptomatic individuals undergoing coronary computed tomography angiography as part of their health screening: 103 with EID-CT in July 2024 and 102 with PCD-CT in January 2025. All scans were acquired using the helical mode. Radiation exposure, iodinated contrast volume, and referral outcomes were compared between those scanned with PCD-CT and with EID-CT.

Results: Baseline characteristics were generally balanced between the two groups except for height, smoking habit, and plasma lipid and glucose concentrations. The PCD-CT group had a lower radiation dose indexed by dose length product (401.0 vs. 633.6 mGy·cm and 421.5 vs. 690.0 mGy·cm for the main scan and for the total procedure, respectively; both P < 0.001) but received higher contrast volume (65.0 vs. 49.0 ml; P < 0.001), as compared with the EID-CT group. All images were of good diagnostic quality, and the rates of referral to invasive coronary angiography (3.9 vs. 4.9%) were similar between the two groups (P > 0.999).

Conclusions: The first-generation PCD-CT, compared with a third-generation EID-CT, offered a substantial reduction in radiation exposure without additional needs for invasive cardiac catheterisation. Further studies using contrast-optimisation technologies and dose-optimisation strategies are warranted to assess diagnostic quality.

Objectives: To evaluate the agreement and comparative performance of non-ECG-gated computed tomography (CT) for coronary artery calcification (CAC) quantification compared with ECG-gated CT and to assess measurement variability between Agatston and volume scoring methods.

Methods: In this retrospective diagnostic accuracy study, 130 patients undergoing pretranscatheter aortic valve implantation received both ECG-gated cardiac CT (3-mm slice) and non-ECG-gated chest CT (5-mm slice) in the same session. Agatston and volume scores were calculated for total CAC and individual vessels. Analyses included receiver operating characteristic curves, Pearson correlation, Fisher's z-transformation, Bland-Altman plots, and Deming regression.

Results: Both methods showed excellent agreement for detecting high-risk CAC [Agatston: area under the curve (AUC), 0.994; volume: AUC, 0.996; P = 0.24]. Correlation between ECG-gated and non-ECG-gated CT was very strong (Agatston: r = 0.978; volume: r = 0.981), with volume scoring significantly outperforming Agatston in the left anterior descending artery (z = -2.02, P = 0.044). Bland-Altman analysis revealed greater bias and wider limits of agreement for Agatston scores. Deming regression showed Agatston scores were consistently underestimated (slope = 0.61), whereas volume scores had slopes closer to unity (1.07), reflecting stronger agreement.

Conclusion: Calcium quantification on non-ECG-gated CT demonstrated strong agreement with ECG-gated reference values. Volume scoring showed superior reproducibility and reduced susceptibility to variability inherent in non-ECG-gated imaging.

Objective: Features of high bleeding risk (HBR) determined by the Academic Research Consortium (ARC) are linked to an enhanced risk of bleeding events among patients undergoing percutaneous coronary intervention. This population-based study investigated whether patients with ARC-HBR are at an increased risk of hospitalization for heart failure (HHF) following drug-eluting stent (DES) implantation by analyzing a large-scale national healthcare database.

Methods: A total of 124 891 patients undergoing DES implantation between 1 January 2007 and 31 December 2019 were identified and divided into two groups: the ARC-HBR group and the non-ARC-HBR group. The incidence rates of HHF of patients were observed. The risk of HHF following DES implantation associated with ARC-HBR features was analyzed using a multivariable Cox proportional hazards model.

Results: The incidence rates (per 1000 person-year) of HHF were 86.9 [95% confidence interval (CI): 84.3-89.6] for ARC-HBR patients and 28.8 (95% CI: 28.3-29.3) for non-ARC-HBR patients during a mean follow-up of 4.6 ± 2.9 years. After adjustment for clinical variables, ARC-HBR patients exhibited an increased risk of HHF [adjusted hazard ratio (aHR): 1.13, 95% CI: 1.08-1.19, P  < 0.001], particularly among patients without a prior history of HHF (aHR: 1.31, 95% CI: 1.24-1.39, P  < 0.001). These results remained consistent for patients who adhered to greater than or equal to 6 months of dual antiplatelet therapy.

Conclusion: ARC-HBR patients exhibited a higher risk of HHF following DES implantation than non-ARC-HBR patients. These results highlight that the ARC-HBR feature is of clinical importance in identifying individuals at a heightened risk of developing HHF following DES implantation.

Background: Elevated lipoprotein(a) [Lp(a)] and low high-density lipoprotein-cholesterol (HDL-C) are established cardiovascular (CV) risk factors, but their combined impact on mortality and sex differences remains unclear.

Methods: This retrospective study analyzed 97 396 patients with measured Lp(a) and HDL-C. Groups were stratified by Lp(a) (≥50 vs. <50 mg/dl) and HDL-C [low (<40), optimal (40-60), high (>60 mg/dl)]. Mortality was assessed using the Kaplan-Meier curve and Cox models.

Results: Over a median of 5.9 years, 7794 deaths occurred. Compared to optimal HDL-C/low Lp(a) (reference), high HDL-C/low Lp(a) had the lowest mortality [adjusted hazard ratio (aHR): 0.85; 95% confidence interval (CI): 0.80-0.91], while low HDL-C/high Lp(a) had the highest risk (aHR: 1.55; 1.41-1.71). High HDL-C protective effect was insignificant with elevated Lp(a) (aHR: 0.98; 0.89-1.08). Sex-stratified analyses revealed divergent effects: women with high HDL-C/high Lp(a) retained the HDL-C protective effect (aHR: 0.82; 0.72-0.93), whereas men faced increased risk (aHR: 1.22; 1.05-1.42).

Conclusion: Elevated Lp(a) enhances mortality risk despite elevated HDL-C levels, with sex-specific differences: women retain mortality benefits from high HDL-C despite elevated Lp(a), whereas men with concurrent elevations in HDL-C and Lp(a) experienced mortality risks comparable to those with low HDL-C. Findings underscore sex-specific CV risk stratification incorporating HDL-C and Lp(a), challenging the HDL-C universal protective role.

Background: Coronary microvascular dysfunction (CMD) is present in approximately 40% of patients with ischemia with no obstructive coronary arteries (INOCA) and has been associated with inflammation. We investigated associations between measures of inflammation of the coronary perivascular adipose tissue assessed by coronary computed tomography angiography (CCTA) and results of invasive coronary function testing (CFT) to diagnose CMD.

Methods: Adults referred for clinically indicated invasive coronary angiography who had less than 50% stenosis in all epicardial arteries were prospectively enrolled. CMD was defined as a coronary flow reserve (CFR) less than 2.5 or index of microvascular resistance (IMR) greater than or equal to 25 using bolus thermodilution in the left anterior descending (LAD) coronary artery. Coronary perivascular fat attenuation index was assessed by CCTA in the right coronary artery (RCA) and LAD. T tests were used to evaluate differences in perivascular FAI by CMD status.

Results: A total of 31 participants underwent CFT and CCTA. The mean age was 58 ± 11.7 years, 77% were female, and 61% were white. CMD was present in 15 participants (48%). No differences in perivascular FAI were observed in patients with and without CMD, either in the RCA [-74.2 ± 9.8 vs. -69.9 ± 10.3 Hounsfield units (HU), P = 0.24] or LAD (-76.4 ± 10.2 vs. -74.8 ± 12.7 HU, P = 0.69). Perivascular FAI was not correlated with CFR or IMR measurements in the RCA or LAD.

Conclusion: There were no associations between CMD diagnosed by invasive CFT and perivascular FAI by CCTA in patients with INOCA. Further research is needed to understand the relationship between vascular inflammation and CMD in INOCA.

Objective: The aim of this study was to explore the safety and efficacy of drug-eluting stents (DES) combined with drug-coated balloons (DCB) in the treatment of complex coronary artery lesions.

Methods: In total, 305 patients with complex coronary artery lesions who underwent percutaneous coronary intervention were retrospectively included in this study. The patients were divided into the DES combined with the DCB treatment group (hybrid group) and the DES-only treatment group (DES group), and the target lesion revascularization (TLR) and major adverse cardiovascular events (MACE) were compared between the two groups during 2-year follow-up.

Results: There were no significant differences between the two groups in baseline clinical characteristics ( P  > 0.05). In the treated lesions of reference vessel diameters (RVD) ≥3 mm, there were no significant differences in coronary angiography and interventional characteristics between the two groups. In the treated lesion of RVD <3mm, the hybrid group had a higher proportion of lesion preparation ( P <0.001) and a higher rate of residual stenosis ( P <0.001) than the DES group. During the 2-year follow-up, the clinical outcomes between the two groups showed no significant differences. After propensity score matching, there were still no significant differences between the two groups in the cumulative survival rates without TLR (95.8% vs. 94.2%; log-rank P  = 0.560) or MACE (89.4% vs. 87.8%; log-rank P  = 0.578) at 2-year follow-up.

Conclusion: During the 2-year follow-up, DES combined with DCB treatment showed similar efficacy and safety compared with DES-only treatment in complex coronary artery lesions.

Background: Coronary artery disease (CAD) and atrial fibrillation (AF) are significant cardiovascular conditions with substantial health and economic burdens. Despite advancements in treatment, long-term mortality trends among individuals with both conditions remain underexplored. This study investigates age-adjusted mortality rates (AAMRs) from 1999 to 2020 and examines trends to address these gaps and highlight demographic and geographic disparities.

Methods: Mortality data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database were analyzed for cases where CAD (ICD-10 codes I20-I25) and AF (ICD-10 code I48) were either contributing or underlying causes of death. Individuals aged 25 years and older were included in the analysis. AAMRs were calculated using direct standardization to the 2000 USA population, and trends were assessed using Joinpoint regression analysis. Mortality trends were stratified by sex, race, geography, and urbanization to identify disparities.

Results: Between 1999 and 2020, AAMRs for CAD- and AF-related mortality increased from 14.4 to 23.4 per 100 000, with an average annual percent change of +2.2% (95% confidence interval: 2.0-2.4). Men consistently exhibited higher overall AAMRs than women (22.9 vs. 13.1 ). Non-Hispanic (NH) White individuals had the highest AAMR (18.6), followed by NH American Indians (12.3), NH Blacks (10.0), Hispanics (9.4), and NH Asians (8.0). Rural areas experienced significantly higher AAMRs than urban areas (19.2 vs. 16.6). AAMRs were disproportionately higher in Western (17.7) and Midwestern USA regions (17.7). States in the top 90 th percentile reported nearly double the AAMRs compared to those in the bottom 10 th percentile.

Conclusion: Mortality rates associated with coexisting CAD and AF have significantly increased, with the most pronounced rise occurring after 2018. The findings reveal substantial disparities across sex, race, and geography. Targeted interventions are essential to address these inequalities, improve health outcomes, and reduce the growing burden of CAD and AF-related mortality.