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Background and objective: In patients with acute myocardial infarction and multivessel disease, the timing of intervention to non-culprit lesions is still a matter of debate, especially in patients without shock. This study aimed to compare the effect of multivessel intervention, performed at index percutaneous coronary intervention (PCI) (MVI-I) or index hospitalization (MVI-S), on the 30-day results of acute myocardial infarction (AMI), and to investigate the effect of coronary lesion complexity assessed by the Syntax (Sx) score on the timing of multivessel intervention. M We enrolled 180 patients with MVI-I, and 425 patients with MVI-S. The major adverse cardiovascular events (MACE) for this study were identified as mortality, nonfatal myocardial infarction, nonfatal stroke, acute heart failure, ischemia driven revascularization, major bleeding, and acute renal failure developed within 30 days. aterials and m ethods: We enrolled 180 patients with MVI-I, and 425 patients with MVI-S. The major adverse cardiovascular events (MACE) for this study were identified as mortality, nonfatal myocardial infarction, nonfatal stroke, acute heart failure, ischemia driven revascularization, major bleeding, and acute renal failure developed within 30 days. Results: The unadjusted MACE rates at 30 days were 11.2% and 5% among those who underwent MVI-I and MVI-S, respectively (OR 3.02; 95% confidence interval (CI) 1.51⁻6.02; p =0.002). Associations were statistically significant after adjusting for covariates in the penalized multivariable model (adjusted OR 2.06; 95%CI 1.02⁻4.18; p =0.043), propensity score adjusted multivariable model (adjusted OR 2.46; 95%CI 1.19⁻5.07; p =0.015), and IPW (adjusted OR 2.11; 95%CI 1.28⁻3.47; p =0.041). We found that the Syntax score of lesions did not affect the results. Conclusion: MVI-S was associated with a lower incidence of major adverse cardiovascular events within 30 days after discharge., Competing Interests: The authors declare no conflict of interest.

Objective: To investigate the safety and efficacy of a percutaneous revascularization strategy that is based on the use of drug-coated balloon for the treatment of patients with acute coronary syndrome and de novo Medina type 0,1,0 or 0,0,1 left main stem bifurcation lesions. Methods: In this multicenter, prospective, proof-of-concept study, patients fulfilling the above criteria were enrolled and received treatment with drug-coated balloon combined with provisional drug-eluting stent implantation in the proximal major branches of the left main stem. Patients who declined this revascularization approach were treated with drug-eluting stent implantation 1-2 mm distally to the left anterior descending or left circumflex artery ostium followed by drug-coated balloon therapy for the ostial disease. The primary endpoint of the study was the calculation of percent diameter stenosis on quantitative coronary angiography post-procedure as well as event rate at 8 months follow-up. Results: A total of 30 patients were enrolled in the study; their mean age was 60.3 ± 7.8 years, while 22 (73.3%) were male. Twenty-two patients were treated only with drugcoated balloon and provisional drug-eluting stent implantation and 8 had drug-eluting stent implantation followed by drug-coated balloon therapy of the ostium of the left main stem major branch. All the procedures were successful with no immediate complications. The percent diameter stenosis of lesion decreased significantly post-procedure from 87.5% (80.0-90.0) to 20% (17.5-30.0), P < .001. During the follow-up period, no major adverse cardiac events were reported. Conclusions: This proof-of-concept study indicates that ostial drug-coated balloon therapy of the left main stem major branches is safe and effective. Larger clinical data and longer follow-up are needed before advocating its regular use in clinical practice. [ABSTRACT FROM AUTHOR]

The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability. [ABSTRACT FROM AUTHOR]

Elevated left ventricular end-diastolic pressure (LVEDP) is associated with adverse outcomes among those patients with ST-elevation myocardial infarction (STEMI).We aim to investigate the acute change of LVEDP in patients with STEMI and the relationship between LVEDP and early reperfusion parameters, such as ST-segment resolution (STR%) and myocardial blush grade (MBG). A total of 51 consecutive patients with STEMI who had undergone successful primary percutaneous coronary intervention (pPCI) with TIMI flow grade 3 were included in the study. LVEDP measurements were performed at the beginning (pre-pPCI LVEDP) and end of (post-pPCI LVEDP) the pPCI. MBG was defined after a successful pPCI; STR% was calculated 60 minutes after pPCI. The mean pre-pPCI LVEDP was 22.1 ± 4.8 mmHg and the post-pPCI LVEDP was 19.4 ± 4.8 mmHg. There was a mean 2.7±1.8 mmHg decrease in LVEDP values after pPCI which was statistically significant (95% CI -3.2, -2.2, p value< 0.001). Post-pPCI LVEDP median value was 19 mmHg. The patients were divided into two groups according to median value: there were 26 (51%) patients with post-pPCI LVEDP≤ 19 mmHg and 25 (49%) patients with post-pPCI LVEDP> 19 mmHg. STR% and MBG were significantly different between the two groups (p= 0.03 and p= 0.01). Post-pPCI LVEDP had a moderate negative correlation with MBG (r= -0.438) and STR% (r= -0.501). In this study, we demonstrated that primary PCI might substantially reduce the LVEDP level. Moreover, the LVEDP levels achieved after PCI might be associated with myocardial reperfusion, assessed by STR% on ECG and MBG during angiography. [ABSTRACT FROM AUTHOR]