Angiology最新文献

Using the SYNTAX score (SS) for decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for left main coronary artery (LMCA) revascularization is under scrutiny. This study investigated the clinical outcomes of LMCA revascularization stratified by SS. This multicenter study included 2138 patients recruited between 2015 and 2020 who underwent LMCA disease revascularization using PCI or CABG and were categorized based on their SS into three groups: low (≤22), intermediate (23-32), and high (≥33). Patients with a high SS compared with those with an intermediate SS experienced increased hospital mortality (Odds ratio: 1.99; P = .026) and Major Adverse Cardiac and Cerebrovascular Event (MACCE; OR: 2.17; P = .006). With an average follow-up of 24.7 months, no substantial differences emerged in MACCE (Hazard ratio: 1.23; P = .52) or mortality (HR: 3.26; P = .073] between patients with high and intermediate SSs. A significant interaction between the SS category (low vs intermediate) and LMCA revascularization modality was observed for hospital MACCEs, favoring PCI over CABG (OR: 0.32; P = .033). However, no noteworthy interactions between SS categories and revascularization modalities were noted concerning hospital or follow-up mortality or follow-up MACCEs. These findings raise doubts about the utility of SS alone in selecting left-main revascularization modalities for LMCA disease.

The left internal mammary (thoracic) artery (LIMA), when used as a pedicle graft at the time of coronary artery bypass grafting, is effective and durable. Data concerning the rate and causes of LIMA failure are scant. The aim of this paper is to explore the modes and frequency of sub-optimal LIMA grafts. We examined all cases of invasive graft angiography performed in our cardiothoracic center 2016-2020 and analyzed the quality of the LIMA graft. Of 551 cases, 323 had undergone isolated coronary artery bypass grafting including a LIMA since 2001; of those, 59 (18%) appeared sub-optimal; 16 (5%) being totally occluded, 26 (8%) exhibiting a "string sign" (i.e., atretic or cord-like), 12 (4%) being focally stenosed, and 5 (1.5%) being patent but placed on a diseased portion of the left anterior descending artery or other vessel. The commonest cause of failure were poor-quality left anterior descending artery target and non-flow-limiting disease. This paper highlights the low rate, and likely modes, of failure of this valuable treatment in contemporary practice.

Acute coronary syndromes (ACS) are one of the most common causes of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the main treatment strategy to restore myocardial perfusion. However, the no-reflow phenomenon (NRP) may block coronary flow. The present study focused on assessing and contrasting predictive parameters for NRP in ACS patients. Our research is a retrospective analysis. We assessed the parameters significantly associated with NRP using Cox regression and Receiver operating characteristic (ROC) Curve analysis. The study included 5122 patients who met the criteria. The average age of the patients was 63.9 + 13.2, and 74.4% were male. It was observed that NRP developed in 1.8% of all patients. Age, hemoglobin (Hb), white blood cell (WBC), glucose and low density lipoprotein cholesterol (LDL-C) were determined to be independent predictors of NRP. The power of these parameters to predict NRP was similar, and WBC was the most predictive (Area Under Curve (AUC): 0.605 95% CI: 0.539-0.671, P = .001). We believe that the use of these simple, practical, and routinely used hematological and biochemical parameters will help us predict the risk of developing NRP before pPCI. This information should improve management.

Patients with chronic-limb threatening ischemia (CLTI) and peripheral wounds might be predisposed for systemic infections. The study aimed to describe the rate of systemic infections in patients with CLTI compared with peripheral artery obstructive disease (PAOD) patients without CLTI, both independently of endovascular treatment (EVT) and after EVT. Administrative data of the AOK Baden-Wuerttemberg (AOK BW) from patients with PAOD were analyzed considering bloodstream infection (BSI), 30-day readmission and prescribed antibiotics for ischemic ulcers. The risk of BSI increased 3.9-fold (95% CI: 3.4-4.4) in patients with PAOD Rutherford-Becker category (RBC) 5 and 6 (n = 11,741) compared with PAOD RBC 1-4 (n = 23,482; 6.81% vs 1.67%, P < .01). The risk of Staphylococcus aureus BSI increased 5.6-fold (95% CI: 4.1-7.7) comparing RBC 5 and 6 (1.2%) with RBC 1-4 (0.22%, P < .01). Outpatient antibiotic prescriptions were dominated by aminopenicillins with β-lactamase inhibitors, accounting for 34.9%. Clindamycin, cefuroxime, and fluoroquinolones represented 14.9%, 13.5%, and 12.6% of prescriptions, respectively. Infections were responsible for 7.7% of 30-day readmissions following EVT. Patients with CLTI are at risk of developing BSI, and specifically S. aureus BSI. Infection-related causes in 30-day readmissions following EVT are common. The high use of clindamycin and cefuroxime in outpatients is concerning.

Exosomes refer to a group of extracellular vesicles naturally released from mammalian cells with a diameter of 30-150 nm. Exosomes contain a variety of biologically active molecules, such as cytoplasmic proteins, chemokines, cytokines, and microRNA (miRNA). They are widely involved in intercellular communication and regulate the behavior of recipient cells. Venous thrombosis is a pathological change caused by vascular endothelial cell damage, hemodynamic changes, and the hypercoagulable state of blood. Exosomes from different cell sources are involved in the process of venous thrombosis. Exosomes can also be used as therapeutic carriers for tissue regeneration and drug delivery. Therefore, the study of exosomes is crucial for the formation, diagnosis, and treatment of venous thrombosis. In this review, we summarize the biological characteristics of exosomes and their mechanism of action in venous thrombosis. In addition, we also focused on its potential clinical applications, including as a diagnostic marker and therapeutic carrier for venous thrombosis.

Lipid ratio is a balance between atherogenesis and antiatherogenesis. it is an important predictive marker of carotid plaque. The lipid ratios, which include non-high-density lipoprotein cholesterol (non-HDL-C)/high-density lipoprotein cholesterol (HDL-C), remnant cholesterol (RC)/HDL-C, apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1), low-density lipoprotein cholesterol (LDL-C)/HDL-C, ApoB/HDL-C, total cholesterol (TC)/HDL-C, triglycerides (TG)/HDL-C, were included and analyzed. Sex differences in the relationship between lipid ratios and carotid plaque were discussed. The risk of carotid plaque was found to be significantly associated with the Non-HDL-C /HDL-C, RC/HDL-C, ApoB/ApoA1, LDL-C /HDL-C, ApoB/HDL-C, TC/HDL-C in females but not in males. The ApoB/HDL risk presented the highest relationship with carotid plaque in females only. The predictive value of the aforementioned lipid ratios for carotid plaque was observed in females only.

Coronavirus 2019 (COVID-19) infection has a significant mortality rate. Despite the disease's extensive effects, little is known about the prognostic indicators that can be used. We aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR) and platelet-to- lymphocyte ratio (PLR) in predicting mortality of intensive care unit (ICU) patients. Demographic data, underlying diseases, laboratory parameters were evaluated. The study included 222 cases. The mortality rate was 57.65%. No significant differences in terms of sex, age, or underlying disease were observed between the two groups with and without mortality. Obesity, oxygen therapy, invasive mechanical ventilation (IMV) rates and high SOFA (Sequential Organ Failure Assessment) scores were found to be significantly higher in the group with a mortal course. The mortality rate was significantly higher in patients with lung involvement over 50%, with a low lymphocyte count at ICU admission. In this patient group, NLR was found to be higher, and LCR was found to be lower (P = .001). Although there was no significant difference in PLR between the two groups in univariate analysis, multivariate analysis revealed that PLR was independently associated with mortality. High NLR and low LCR values at ICU admission might serve as early warning signs for healthcare providers, allowing them to identify patients at higher risk of mortality.

Silent new ipsilateral ischemic lesions (sNIIL) detected by diffusion-weighted imaging (DWI) are commonly observed after carotid artery stenting (CAS). We aimed to analyze the association of carotid plaque characteristics on Virtual Histology Intravascular Ultrasound (VH-IVUS) with sNIIL, which is not well understood. Among 128 patients who underwent CAS and VH-IVUS, 112 patients who underwent DWI within 72 h after CAS were included for analysis. VH-IVUS detected cross-sectional composition of plaques including necrotic core (NC), dense calcium (DC), fibrous (FI), and fibrofatty (FF) in each frame. Plaques with ≥3 consecutive thin-cap fibroatheroma (TCFA) or calcified thin-cap fibroatheroma (CaTCFA) frames were defined as vulnerable. Logistic regression was applied to evaluate the association between plaque characteristics and sNIIL. A total of 56 patients (50%) had sNIIL. Larger NC in the maximum NC frame (odds ratio [OR] = 1.35; 95% confidence interval [CI]: 1.03-1.75; P = .029) and defined vulnerable plaques (OR = 3.89; 95% CI: 1.68-9.01; P = .001) were associated with sNIIL. Incidence of sNIIL showed an escalating trend with the increase of quartiles of NC (P_trend = .010). The findings of this study suggest that composition and distribution characteristics of carotid plaques on VH-IVUS during CAS have potential clinical significance.