Angiology最新文献

This prospective cohort study evaluated the prognostic value of the triglyceride-glucose (TyG) index and its metabolic mediation pathways in 16 499 patients with complex coronary lesions (American College of Cardiology/American Heart Association type B2/C) undergoing percutaneous coronary intervention (PCI). Over a median 3-year follow-up, 535 patients (3.2%) experienced cardiovascular (CV) events. Patients in the highest TyG tertile (T3: >9.10) demonstrated a 2.442-fold increased CV risk compared with the lowest tertile (T1: <8.63; 95% CI 1.923-3.102, P < .001), with a significant dose-response relationship (P-trend < .001). Structural equation modeling revealed that metabolic burden (hypertension, dyslipidemia, type 2 diabetes mellitus) mediated 50.0% of TyG-associated risk (indirect effect P = .038). TyG index exhibited superior predictive accuracy for CV events compared with the TG/HDL-C ratio (area under the curve [AUC] 0.617 vs 0.577, P = .004), though their combination did not significantly improve discrimination over TyG alone (△AUC = 0.001, P = .694). Type 2 diabetes mellitus accounted for 62.3% of the mediation effect, surpassing hypertension (20.8%), and dyslipidemia (16.9%). These findings establish the TyG index as an independent predictor of CV outcomes in complex coronary lesions, with metabolic comorbidities explaining half its prognostic impact. Integration of TyG-driven metabolic phenotyping may optimize risk stratification and targeted interventions in high-risk PCI populations.

Arteriovenous malformations (AVMs) are rare, congenital, high-flow vascular anomalies, that may become aggressive and threatening, especially in the extremities. We present the case of a 42-year-old male with a congenital AVM of the non-dominant hand, who presented at our emergency department with spontaneous, life-threatening hemorrhage. Despite previous embolization attempts, the lesion had progressed to Schobinger stage III. The patient underwent emergent mid-forearm amputation, which successfully controlled the hemorrhage and provided significant pain relief. Two years postoperatively, he remains free of recurrence, with excellent functional and psychological recovery. A comprehensive literature review was also performed, highlighting the role of amputation as a last-resort, but sometimes life-saving, intervention in advanced extremity AVMs. Although embolization and surgical resection remain the cornerstones of treatment, amputation may be necessary in cases of intractable symptoms, recurrent complications, or failure of other therapies. A multidisciplinary, patient-centered approach is critical for decision-making and optimal long-term outcomes.

The present study explored the potential protective effects of a proprotein-converting enzyme subtilisin/kexin 9 inhibitor (evolocumab) against contrast-associated acute kidney injury (CA-AKI) in high-risk patients with atherosclerotic cardiovascular disease(ASCVD). This retrospective cohort study included patients who underwent percutaneous coronary intervention at Tianjin Chest Hospital between January 2020 and December 2021. The endpoint was the incidence of CA-AKI. Bias matching was used to mitigate the impact of selection bias and other potential confounding factors. This study included 1642 patients, with 821 receiving evolocumab treatment (subcutaneous injection of 140 mg evolocumab within 2 days before undergoing PCI) before contrast agent administration and 821 not receiving this treatment. The incidences of CA-AKI were 6.21% and 8.04% in the evolocumab and control groups, respectively (P = .150). After propensity score matching, the incidence was 4.52% and 8.47% in the evolocumab and control groups (P = .009), respectively. These findings suggest that evolocumab treatment significantly reduced the occurrence of CA-AKI. These results were consistent across the subgroups of individuals with varying risk scores. Evolocumab administration effectively reduces the incidence of CA-AKI in inpatients with ASCVD, with a notable effect in high-risk individuals with CA-AKI.