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Introduction: Despite the increasing number of complex percutaneous coronary interventions (CPCI), data regarding outcomes following CPCI in patients with diabetes mellitus (DM) are scarce. Hypothesis: Compared to the general population, diabetic patients undergoing CPCI have worse prognosis. Methods: We analyzed data of patients who underwent PCI in a tertiary-care center between 2009 and 2017. Patients were divided into 2 groups (CPCI and non-CPCI) stratified by presence of DM. CPCI was defined as having ≥1 of the following: stent length >60 mm, ≥3 stents implanted, ≥3 lesions, ≥3 target vessels, bifurcation with ≥2 stents, or chronic total occlusion. The main outcome was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR) at 1 year. Results: Out of 20,412 patients included, 5,038 (24.7%) underwent CPCI. Patients with DM constituted 46.5% (n=9,494) of the overall cohort and 44.5% (n=2,240) of CPCI group. Among patients undergoing CPCI, diabetics were younger, more likely to be female, and had more cardiovascular risk factors (kidney disease, dyslipidemia, and hypertension) than non-diabetics. In addition, diabetic patients had more advanced coronary disease (multivessel disease, high syntax score, and longer lesion length). At 1 year, diabetic patients had higher risk of MACE than non-diabetic, regardless of PCI complexity ( Figure 1 ). Nonetheless, there was a significant interaction between CPCI and diabetes in terms of mortality at 1 year (p-interaction=0.009). In contrast, compared to non-diabetics, a higher risk of TVR ( adj HR 1.49, 95% CI [1.24 - 1.78], p adj HR 1.45, 95% CI [1.05 - 1.98], p=0.02) was observed in diabetics undergoing non-CPCI but not CPCI. Conclusion: Diabetic patients are at higher risk of MACE than the general population regardless of PCI complexity. Yet, 1-year mortality is substantially higher in diabetics undergoing CPCI than non-CPCI.

Introduction: Prognosis in high-bleeding risk (HBR) patients after percutaneous coronary intervention (PCI) is largely dependent on risk of ischemic/bleeding events. Inflammation is known to increase the ischemic risk following PCI in the general population, yet its impact on HBR patients remains unknown. Hypothesis: We assessed the hypothesis that inflammation, as reflected by elevated high-sensitivity C - reactive protein (hsCRP), increases the risk of ischemic and bleeding events in HBR patients undergoing PCI. Methods: We included patients who underwent PCI at a tertiary care center between 2014 and 2017. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the Academic Research Consortium (ARC)-HBR consensus. Patients were then stratified into high (≥3 mg/l) and low (10 mg/l were excluded. The main outcomes of interest were major adverse cardiac events (MACE) (composite of all-cause death, MI, and target vessel revascularization) and bleeding events. Results: Out of 7,186 patients included, 3,403 (42.3%) fulfilled the ARC-HBR definition of whom 1,046 (34.4%) had high hsCRP. These patients were frequently female, younger, and had more cardiovascular risk factors (diabetes, kidney disease, and peripheral artery disease) yet similar angiographic features (multivessel disease, syntax score, and lesion length) than those with low hsCRP. Although risk of MACE at 1 year was similar in HBR patients with either high or low hsCRP, mortality risk was significantly higher in the former group ( Figure 1 ). In addition, HBR patients with high hsCRP were more likely to have periprocedural bleeding (OR 1.72, 95% CI [1.14-2.58], p=0.01) but similar risk of 1-year major bleeding as HBR patients with low hsCRP ( Figure 1 ). Conclusion: In conclusion, inflammation is associated with periprocedural bleeding and 1-year mortality in HBR patients undergoing PCI.

Introduction: Cardiovascular disease is the leading cause of mortality worldwide, irrespective of race/ethnicity. Previous studies reported that minority patients with ACS have distinct clinical, genetic and socioeconomic backgrounds that may affect clinical outcomes. Hypothesis: To investigate post percutaneous coronary intervention (PCI) outcomes according to race/ethnicity in a contemporary ACS population. Methods: We included consecutive patients undergoing drug-eluting stent implantation for STEMI, non-STEMI or unstable angina (UA) between 2012-2017. The study population was stratified into Caucasian, African American, Hispanic and Asian. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, spontaneous myocardial infarction or stroke at 1 year. Results: Of the 6800 patients included, 3377 (49.7%) were Caucasian, 1408 (20.7%) Hispanic, 1156 (17.0%) Asian and 859 (12.6%) African American. Caucasians were the oldest, Hispanics and Asians had the highest prevalence of diabetes mellitus (DM) and African Americans had more insulin dependent DM and chronic kidney disease. Hispanics and African Americans had the highest STEMI rate, while Asians were more likely to present with UA, have private insurance and be discharged on aspirin and clopidogrel. Compared to Caucasians, Asians had a lower rate of MACCE at 1 year (3.9% vs. 7.1%; p Conclusions: Among patients undergoing PCI for ACS, Asian race is associated with favorable cardiovascular outcomes compared to Caucasian. No significant differences were observed for Hispanics and African Americans.

Coronary calcification increases risk for adverse events in patients undergoing PCI with bare-metal or first-generation drug-eluting stents. Newer generation devices, however, are safer and more efficacious. Whether coronary calcification relates to risk in the newer generation DES era is unclear. We assessed the hypothesis that target lesion calcification in patients undergoing PCI with newer generation DES is associated with specific patient characteristics and clinical outcomes. We performed a retrospective analysis of a large, multiethnic cohort of patients undergoing PCI (n=14,054) with new generation DES at a single academic center between 2009 & 2013. Coronary calcification was qualitatively assessed as none/mild, moderate or severe. Independent demographic, clinical and anatomic predictors of moderate/severe calcification were identified using logistic regression. Associations between coronary calcification and one-year MACE (death, MI or TVR) were examined using Cox modeling. Compared to patients with none/mild (n=11,530; 82.0%) those with moderate (n=1423; 10.0%) or severe (n=1101; 8.0%) coronary calcification were older, more often Caucasian, and had more complex target lesions and greater renal dysfunction. The strongest demographic, clinical and anatomic correlates of moderate/severe calcification were Caucasian race, renal dysfunction and left main target lesion. Unadjusted MACE rates among those with none/mild, moderate and severe calcification were 9.0, 14.7, and 17.9%, respectively (p Despite the improved safety and efficacy profile of new generation DES, moderate to severe target lesion coronary calcification is not uncommon in the contemporary DES era and remains a strong and independent predictor of MACE after PCI.

Introduction: Women experience higher complication rates and mortality after PCI than men but it remains unknown whether these differences are sustained among younger and older patients. Hypothesis/Objectives: To investigate if previously reported gender-based disparities in outcome following percutaneous coronary intervention (PCI) are modified by age in a large and racially-diverse cohort in the drug eluting stent (DES) era. Methods: A total of 23,400 patients (7942 female, 34%) underwent PCI of de novo lesion(s) from 01/2005 to 12/2012 at Mount Sinai Hospital. We compared demographics, procedural characteristics, and 1-year rates of death, myocardial infarction, and major adverse cardiovascular events (MACE), by sex in younger (≤65 years old, n=11,381) and older (>65 years old, n= 12,019) patients. Results: Regardless of age, compared to males, females had higher body mass index (BMI), better renal function, smoked less, but were more hypertensive and diabetic. Women had higher HDL and LDL cholesterol levels. More women presented with an unstable coronary syndrome and required left anterior descending artery PCI. Women had more vascular and bleeding complications post-PCI but the 30-day readmission rate did not differ between genders within age groups. At 1 year women, in both age categories, were at higher risk for death or myocardial infarction than men. Among younger patients, women had more MACE than men, but formal interaction testing was negative (Figure). Conclusion: Females undergoing PCI have more comorbidities and are at higher risk for unfavorable outcomes than males. The substantial gender-based differences in clinical outcomes following PCI were independent of age suggesting that preventive strategies should be promoted amongst women.

> Among the many useful discoveries which this age has made, there are very few which better deserve the attention of the public that what I am going to lay before your Lordship. > > —Reverend Edward Stone –Chipping-Norton, Oxfordshire –April 25, 1763 These prophetic words, written by Reverend Edward Stone in a 1763 letter to George Parker, the second Earl of Macclesfield, describe the results of the first clinical trial recorded in medical history.1 Stone's report on the rediscovery of the medicinal value of willow bark among subjects suffering from malarial symptoms is considered a significant milestone in the development of aspirin. Although society now takes many of its beneficial effects for granted, aspirin did not suddenly appear for medicinal use after Reverend Stone's discovery. Instead, its tumultuous journey was fueled by individual scientific curiosity, accidental discoveries, and intense business rivalry.1 No other drug is used by a greater number of people worldwide than aspirin, the benefits of which span centuries, beginning with the very first uses of willow bark by Egyptian physicians (Figure 1). Aspirin single-handedly transformed a coal-dye company into a pharmaceutical giant and has emerged as a cornerstone in the present-day therapies available for treating cardiovascular disease (CVD), pain, and inflammation. This article discusses the sentinel historical aspects of the discovery and clinical cardiovascular developments of aspirin, as well as its contemporary use in today's medical arena. Figure 1. Timeline of historical events in the development of aspirin. ### Historical Developments of Salicylates On January 20, 1862, Edwin Smith made one of the most historically important purchases of his life. Well-regarded among his peers for his keen scholarship and intricate knowledge of Egyptology, Smith purchased, for £12, 2 worn papyrus scrolls in a local Luxor street market1 that later turned out to be a formative medical textbook unlocking ancient Egyptian's practice of medicine. Although authorless, the Ebers Papyrus is 110 pages …