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Background: Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for structural valve degeneration following surgical aortic valve replacement (SAVR) or prior TAVI. However, the understanding of long-term complications and their management remains limited. Case presentation: We present the case of a 69-year-old male with a history of ViV-TAVI, who presented with symptoms of non-ST elevation myocardial infarction (NSTEMI) and transient ischemic attack (TIA). Computed tomography (CT) revealed thrombosis of the ascending aortic graft and aortic valve prosthesis. Transthoracic echocardiography (TTE) further confirmed new valve dysfunction, indicated by an increase in the aortic valve mean gradient. Treatment with low-molecular-weight heparin (LMWH) resulted in partial thrombus resolution. The multidisciplinary Heart Team opted against coronary angiography and recommended the long-term administration of vitamin K antagonists (VKAs). Follow-up CT showed the complete resolution of the thrombus. Conclusions: Thrombosis of the aortic graft and aortic valve following ViV-TAVI may be attributed to alterations in blood flow or mechanical manipulations during the TAVI procedure, yet it can be effectively managed with VKA therapy. CT is a valuable tool in coronary assessment in patients with NSTEMI and aortic valve and/or aortic graft thrombosis.

The noticeable dynamic development of electromobility poses new challenges for the energy industry and users of electric vehicles. One of these challenges is coping with the change in the way we refuel. In the case of electric vehicles, the batteries can also be charged via home electrical installations. The presence of a new, non-linear load with significant power may affect the quality parameters of electricity in this installation and therefore indirectly affect the operation of other loads. In order to investigate the possible impact of the electric vehicle charging process on these parameters, a number of measurements were carried out. This paper presents the results of observing voltage distortions in the installation as a result of the harmonics of the current supplying the AC/DC converter in the vehicle. The test results confirm the compliance of the voltage with the requirements of the standards; however, the large share of current harmonics requires the analysis of the anti-shock protections existing in the installation to ensure that they are effective when currents at higher frequencies flow. The research results may be a guide for designers and users of home electrical installations.

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.

The aim of this article is to determine the effect of the addition of dispersed reinforcement on the resilient modulus of non-cohesive soil used as material for improved subgrade or subbase course of the pavement structure. Resilient modulus (Mr) is a parameter used in road construction, which characterises soil subgrade or base aggregates stiffness in flexible pavement subjected to the traffic load. This article presents laboratory test results of non-cohesive coarse material (gravelly sand – grSa – without fines) with the addition of 1.5% cement and dispersed reinforcement – polypropylene fibres in lengths of 12, 18 and 40 mm. Tests were conducted on the samples with various percentages of fibres (0, 0.2 and 0.3%) relating to the dry mass of the soil. Samples were compacted according to the standard Proctor (SP) and modified Proctor (MP) methods. Main laboratory tests were conducted in the triaxial apparatus enabling testing samples subjected to cyclic loads according to AASHTO T307 standard. Resilient modulus was determined after 7 and 28 days of curing. The results indicate the influence of fibre amount, fibre length, and curing time on the Mr of the soil modified with 1.5% of cement. The obtained results were also influenced by the method of compaction. The addition of polypropylene fibres decreases the resilient modulus of soil stabilised by 1.5% of cement. The best results of dispersive reinforcement were obtained for samples containing 0.3% of fibres with a length of 18 mm, compacted by the MP methods.

The classic test for soil or aggregate bearing capacity in road construction is the CBR test. The results of the CBR were determined for gravelly sand and sand with the addition of 1.5% cement, as well as for their mixtures with 18 mm long polypropylene fibres in the amounts of 0.1%, 0.2% and 0.3%. The effect of compaction and time of curing of samples stabilised with hydraulic binder were also determined. The natural soil without cement and fibre additions had relatively high CBR values. The additions of 0.1% and 0.2% polypropylene fibres to the dry mass of the soil resulted in an approximately 2-fold increase in the CBR value for the samples compacted using the standard method. Increasing the amount of fibres to 0.3% caused a reduction in the CBR value to that obtained without fibre addition. For samples compacted using the modified Proctor method, the observations are different. Only the sample with 0.2% fibre addition achieved a slightly higher CBR value. Moreover, the addition of 1.5% cement and the length of treatment increased the CBR values.

Abstract It is well known that exceeded levels of particulate matter in the air and other air pollutants harmfully affect the cardiovascular system. Empirical analyses of the effects of these factors on stroke incidence and mortality are still limited. The main objective of our analyses was to determine the association between short-term exposure to air pollutants and stroke incidence in non-industrial areas, more specifically in north-eastern Poland. To achieve this aim, we used data from the National Health Fund on patients hospitalized for stroke between 2011 and 2020 in the largest city of the region described as the Green Lungs of Poland. The pollution levels and atmospheric conditions data were obtained from the Provincial Inspectorate for Environmental Protection and the Institute of Meteorology and Water Management. Using daily data on hospitalizations, atmospheric conditions, and pollution, as well as ordered logistic regression models the hypotheses on the impact of weather and air pollution conditions on ischemic strokes were tested. The study group included 4838 patients, 45.6% of whom were male; the average patient age was approximately 74 years. The average concentrations of PM2.5 were 19.09 µg/m3, PM10 26.66 µg/m3 and CO 0.35 µg/m3. Analyses showed that an increase in PM2.5 and PM10 concentrations by 10 µg/m3 was associated with an increase in the incidence of stroke on the day of exposure (OR = 1.075, 95% CI 0.999–1.157, P = 0.053; OR = 1.056, 95% CI 1.004–1.110, P = 0.035) and the effect was even several times greater on the occurrence of a stroke event in general (PM2.5: OR = 1.120, 95% CI 1.013–1.237, P = 0.026; PM10: OR = 1.103, 95% CI 1.028–1.182, P = 0.006). Furthermore, a short-term (up to 3 days) effect of CO on stroke incidence was observed in the study area. An increase of 1 μg/m3 CO was associated with a lower incidence of stroke 2 days after the exposure (OR = 0.976, 95% CI 0.953–0.998, P = 0.037) and a higher incidence 3 days after the exposure (OR = 1.026, 95% CI 1.004–1.049, P = 0.022).

Cancers often harbor mutations in genes encoding important regulatory proteins, but therapeutic targeting of these molecules proves difficult due to their high structural similarity to their non-mutated counterpart. Here authors show the engineering of T cell engaging bispecific protein able to selectively target cancer cells with a high-frequency mutation in the KRAS oncogene.

Background: Simple surgical and clinical risk scores are useful in mortality prediction. Aims: The study's aim was to validate three scores in real-world registry of percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA). Methods: All data were obtained from the BIA-LM Registry. Discrimination and calibration of EuroSCORE II, ACEF, CHA2DS2-VASc, and CHA2DS2-VA were assessed with receiver operating characteristic (ROC) curves analysis and Hosmer–Lemeshow (HL) test. Results: The final cohort included 851 patients, median age was 71, and 156 patients had history of previous coronary artery bypass grafting (CABG). Median EuroSCORE II, ACEF, CHA2DS2-VASc, and CHA2DS2-VA were 3.1% (IQR 5.4%), 1.56 (IQR 0.9), 4 (IQR 2), and 4 (IQR 2), respectively. In the short- (30 days) and long-term (mean 4.1 years), there were 27 and 318 deaths. In short-term, EuroSCORE II showed the best discrimination in the overall population and subgroup with unprotected LMCA [area under the curve (AUC) 0.804, 95% CI 0.717–0.890 and AUC 0.826, 95% CI 0.737–0.913, respectively, p < 0.001 for comparisons with other models), with the best cut-off value at 7.1%. In long-term observation, EuroSCORE II and ACEF showed good predictive value (overall population: AUC 0.716, 95% CI 0.680–0.750 and AUC 0.725, 95% CI 0.690–760, respectively). In short- and long-term observation, EuroSCORE II and ACEF showed poor calibration (HL test p < 0.05) as compared to CHA2DS2-VASc (HL test p = 0.40 and 0.18). Conclusions: EuroSCORE II showed good mortality prediction in short-term observation; however, its predicted risk should be interpreted with caution due to poor calibration. ACEF and EuroSCORE II may be useful in long-term mortality prediction. [ABSTRACT FROM AUTHOR]

Accurate human posture classification in images and videos is crucial for automated applications across various fields, including work safety, physical rehabilitation, sports training, or daily assisted living. Recently, multimodal learning methods, such as Contrastive Language-Image Pretraining (CLIP), have advanced significantly in jointly understanding images and text. This study aims to assess the effectiveness of CLIP in classifying human postures, focusing on its application in yoga. Despite the initial limitations of the zero-shot approach, applying transfer learning on 15,301 images (real and synthetic) with 82 classes has shown promising results. The article describes the full procedure for fine-tuning, including the choice for image description syntax, models and hyperparameters adjustment. The fine-tuned CLIP model, tested on 3826 images, achieves an accuracy of over 85%, surpassing the current state-of-the-art of previous works on the same dataset by approximately 6%, its training time being 3.5 times lower than what is needed to fine-tune a YOLOv8-based model. For more application-oriented scenarios, with smaller datasets of six postures each, containing 1301 and 401 training images, the fine-tuned models attain an accuracy of 98.8% and 99.1%, respectively. Furthermore, our experiments indicate that training with as few as 20 images per pose can yield around 90% accuracy in a six-class dataset. This study demonstrates that this multimodal technique can be effectively used for yoga pose classification, and possibly for human posture classification, in general. Additionally, CLIP inference time (around 7 ms) supports that the model can be integrated into automated systems for posture evaluation, e.g., for developing a real-time personal yoga assistant for performance assessment.

“Our periodical is for you”. About the journal Głos Siemianowicki (1936–1937) The article aims to present a short history of the magazine Głos Siemianowicki. It was a local newspaper published in Siemianowice Śląskie in the years 1936–1937. On its pages, attempts were made to combat the discrimination of the inhabitants of Siemianowice or the harassment of people of Silesian origin. In addition to local topics, the periodical also provided information about important events, both domestic and foreign. The research method used in this article is the analysis of sources, based on a comprehensive study of the available material. STRESZCZENIE Artykuł ma na celu przedstawienie krótkiej historii pisma Głos Siemianowicki. Była to gazeta lokalna wydawana na terenie Siemianowic Śląskich w latach 1936–1937. Na jej łamach starano się walczyć z przejawami dyskryminacji mieszkańców Siemianowic czy szykanowania ludzi pochodzenia śląskiego. Oprócz tematyki lokalnej periodyk dostarczał także informacji o ważnych wydarzeniach w kraju i za granicą. Zastosowaną metodą badawczą w niniejszym artykule jest analiza źródeł, oparta na całościowym przestudiowaniu dostępnego materiału.

Catheter-induced coronary artery dissection (CICAD) is a rare but very serious complication of invasive diagnostics and percutaneous treatment of coronary artery disease. The incidence of CICAD is < 0.1% [1]. CICAD is usually treated with stent deployment, less often conservatively and only a small percentage of patients require surgical intervention [1, 2]. In this article, we present the case of a patient with CICAD who, after initial conservative therapy, underwent intravascular ultrasound-guided percutaneous coronary intervention (IVUS-guided PCI).

Introduction Atrial fibrillation (AF) is a prevalent disease considerably contributing to the worldwide cardiovascular burden. For patients at high thromboembolic risk (CHA2DS2-VASc ≥3) and not suitable for chronic oral anticoagulation, owing to history of major bleeding or other contraindications, left atrial appendage occlusion (LAAO) is indicated for stroke prevention, as it lowers patient’s ischaemic burden without augmentation in their anticoagulation profile.Methods and analysis Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER) will be conducted in 10 heart surgery and cardiology centres across Poland to assess the outcomes of LAAO performed by fully thoracoscopic-epicardial, percutaneous-endocardial or hybrid endo-epicardial approach. The registry will include patients with nonvalvular AF at a high risk of thromboembolic and bleeding complications (CHA2DS2-VASc Score ≥2 for males, ≥3 for females, HASBLED score ≥2) referred for LAAO. The first primary outcome is composite procedure-related complications, all-cause death or major bleeding at 12 months. The second primary outcome is a composite of ischaemic stroke or systemic embolism at 12 months. The third primary outcome is the device-specific success assessed by an independent core laboratory at 3–6 weeks. The quality of life (QoL) will be assessed as well based on the QoL EQ-5D-5L questionnaire. Medication and drug adherence will be assessed as well.Ethics and dissemination Before enrolment, a detailed explanation is provided by the investigator and patients are given time to make an informed decision. The patient’s data will be protected according to the requirements of Polish law, General Data Protection Regulation (GDPR) and hospital Standard Operating Procedures. The study will be conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the local Bioethics Committee of the Upper-Silesian Medical Centre of the Silesian Medical University in Katowice (decision number KNW/0022/KB/284/19). The results will be published in peer-reviewed journals and presented during national and international conferences.Trial registration number NCT05144958.

Abstract Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed in respiratory, circulatory systems but also in renal function. We decide to investigate the hypothesis indicating that we can observe not only long- but also short-term impact of air pollution on kidney function. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration. 3554 patients (median age 66, men 53.2%) were included into final analysis. Chronic kidney disease (CKD) was diagnosed in 21.5%. The odds of CKD increased with increase in annual concentration of PM2.5 (OR for IQR increase = 1.07; 95% CI 1.01–1.15, P = 0.037) and NO2 (OR for IQR increase = 1.05; 95% CI 1.01–1.10, P = 0.047). The IQR increase in weekly PM2.5 concentration was associated with 2% reduction in expected eGFR (β = 0.02, 95% CI − 0.03; − 0.01). Medium- and short-term exposure to elevated air pollution levels was associated with a decrease in eGFR and development CKD. The main pollutants affecting the kidneys were PM2.5 and NO2.

Background: Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for structural valve degeneration following surgical aortic valve replacement (SAVR) or prior TAVI. However, the understanding of long-term complications and their management remains limited. Case presentation: We present the case of a 69-year-old male with a history of ViV-TAVI, who presented with symptoms of non-ST elevation myocardial infarction (NSTEMI) and transient ischemic attack (TIA). Computed tomography (CT) revealed thrombosis of the ascending aortic graft and aortic valve prosthesis. Transthoracic echocardiography (TTE) further confirmed new valve dysfunction, indicated by an increase in the aortic valve mean gradient. Treatment with low-molecular-weight heparin (LMWH) resulted in partial thrombus resolution. The multidisciplinary Heart Team opted against coronary angiography and recommended the long-term administration of vitamin K antagonists (VKAs). Follow-up CT showed the complete resolution of the thrombus. Conclusions: Thrombosis of the aortic graft and aortic valve following ViV-TAVI may be attributed to alterations in blood flow or mechanical manipulations during the TAVI procedure, yet it can be effectively managed with VKA therapy. CT is a valuable tool in coronary assessment in patients with NSTEMI and aortic valve and/or aortic graft thrombosis. [ABSTRACT FROM AUTHOR]

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann–Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS. [ABSTRACT FROM AUTHOR]

The noticeable dynamic development of electromobility poses new challenges for the energy industry and users of electric vehicles. One of these challenges is coping with the change in the way we refuel. In the case of electric vehicles, the batteries can also be charged via home electrical installations. The presence of a new, non-linear load with significant power may affect the quality parameters of electricity in this installation and therefore indirectly affect the operation of other loads. In order to investigate the possible impact of the electric vehicle charging process on these parameters, a number of measurements were carried out. This paper presents the results of observing voltage distortions in the installation as a result of the harmonics of the current supplying the AC/DC converter in the vehicle. The test results confirm the compliance of the voltage with the requirements of the standards; however, the large share of current harmonics requires the analysis of the anti-shock protections existing in the installation to ensure that they are effective when currents at higher frequencies flow. The research results may be a guide for designers and users of home electrical installations. [ABSTRACT FROM AUTHOR]

Background: The rate of in-stent restenosis (ISR) is decreasing; however, it is still a challenge for contemporary invasive cardiologists. Therapeutic methods, including drug-eluting balloons (DEBs), intravascular lithotripsy, excimer laser coronary atherectomy, and imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents (DES), have been implemented. Patients with diabetes mellitus (DM) are burdened with a higher risk of ISR than the general population. Aims: DM-Dragon is aimed at evaluating the clinical outcomes of ISR treatment with DEBs vs. DES, focusing on patients with co-existing diabetes mellitus. Methods: The DM-Dragon registry is a retrospective study comprising data from nine high-volume PCI centers in Poland. A total of 1117 patients, of whom 473 individuals had DM and were treated with PCI due to ISR, were included. After propensity-score matching (PSM), 198 pairs were created for further analysis. The primary outcome of the study was target lesion revascularization (TLR). Results: In DM patients after PSM, TLR occurred in 21 (10.61%) vs. 20 (10.1%) in non-diabetic patients, p = 0.8690. Rates of target vessel revascularization (TVR), target vessel myocardial infarction, device-oriented composite endpoint (DOCE), and cardiac death did not differ significantly. Among diabetic patients, the risk of all-cause mortality was significantly lower in the DEB group (2.78% vs. 11.11%, HR 3.67 (95% confidence interval, CI) [1.01–13.3), p = 0.0483). Conclusions: PCI with DEBs is almost as effective as DES implantation in DM patients treated for ISR. In DM-Dragon, the rate of all-cause death was significantly lower in patients treated with DEBs. Further large-scale, randomized clinical trials would be needed to support these findings. [ABSTRACT FROM AUTHOR]

Respiratory deficits after C2 hemisection (C2Hx) have been well documented through single-sex investigations. Although ovarian sex hormones enable enhanced respiratory recovery observed in females 2 wk post-C2Hx, it remains unknown if sex impacts spontaneous respiratory recovery at chronic time points. We conducted a longitudinal study to provide a comprehensive sex-based characterization of respiratory neuromuscular recovery for 8 wk after C2Hx. We recorded ventilation and chronic diaphragm electromyography (EMG) output in awake, behaving animals, phrenic motor output in anesthetized animals, and performed diaphragm muscle histology in chronically injured male and female rodents. Our results show that females expressed a greater recovery of tidal volume and minute ventilation compared with males during subacute and chronic time points. Eupneic diaphragm EMG amplitude during wakefulness and phrenic motor amplitude are similar between sexes at all time points after injury. Our data also suggest that females have a greater reduction in ipsilateral diaphragm EMG amplitude during spontaneous deep breaths (e.g., sighs) compared with males. Finally, we show evidence for atrophy and remodeling of the fast, fatigable fibers ipsilateral to injury in females, but not in males. To our knowledge, the data presented here represent the first study to report sex-dependent differences in spontaneous respiratory recovery and diaphragm muscle morphology following chronic C2Hx. These data highlight the need to study both sexes to inform evidence-based therapeutic interventions in respiratory recovery after spinal cord injury (SCI). NEW & NOTEWORTHY: In response to chronic C2 hemisection, female rodents display increased tidal volume during eupneic breathing compared with males. Females show a greater reduction in diaphragm electromyography (EMG) amplitude during spontaneous deep breaths (e.g., sighs) and atrophy and remodeling of fast, fatigable diaphragm fibers. Given that most rehabilitative interventions occur in the subacute to chronic stages of injury, these results highlight the importance of considering sex when developing and evaluating therapeutics after spinal cord injury. [ABSTRACT FROM AUTHOR]

In recent years, there has been a clear trend towards increased mitral bioprosthetic valve surgery in comparison to mechanical prostheses [1]. According to the ESC Guidelines mitral bioprostheses are recommended for patients > 70 years old or those with a life expectancy lower than the presumed durability of the bioprosthesis (class IIa/C). Importantly, the guidelines also recognize the prominence of quality of life after cardiosurgery and focus on patients’ preferences (class Ic), especially if long-term anticoagulation is nonoptimal (class Ic) [2]. Structural deterioration of mitral bioprostheses (structural valve deterioration – SVD) is the main limitation for their use. The average lifespan of a bioprosthetic valve is estimated at 16 years and the reoperation due to SVD affects as many as 75% of patients after a 20-year follow-up [3, 4]. Reoperation is usually associated with high risk of complications and mortality [5, 6].

The increasing morbidity and mortality of type 2 diabetic mellitus (T2DM) patients with ischemic heart disease (IHD) highlight an urgent need to identify early biomarkers, which would help to predict individual risk of development of IHD. Here, we postulate that circulating serum-derived micro RNAs (miRNAs) may serve as potential biomarkers for early IHD diagnosis and support the identification of diabetic individuals with a predisposition to undergo IHD. We obtained serum samples from T2DM patients either with IHD or IHD-free and analysed the expression levels of 798 miRNAs using the NanoString nCounter technology platform. The prediction of the putative miRNAs targets was performed using the Ingenuity Pathway Analysis (IPA) software. Gene Ontology (GO) analysis was used to identify the biological function and signalling pathways associated with miRNA target genes. Hub genes of protein-protein interaction (PPI) network were identified by STRING database and Cytotoscape tool. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic value of identified miRNAs. Real-time quantitative polymerase chain reaction (qRT-PCR) was used for nCounter platform data validation. Our data showed that six miRNAs (miR-615-3p, miR-3147, miR-1224-5p, miR-5196-3p, miR-6732-3p, and miR-548b-3p) were significantly upregulated in T2DM IHD patients compared to T2DM patients without IHD. Further analysis indicated that 489 putative target genes mainly affected the endothelin-1 signalling pathway, glucocorticoid biosynthesis, and apelin cardiomyocyte signalling pathway. All tested miRNAs showed high diagnostic value (AUC = 0.779 - 0.877). Taken together, our research suggests that circulating miRNAs might have a crucial role in the development of IHD in diabetic patients and may be used as a potential biomarker for early diagnosis.

BackgroundData regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.ObjectivesThis study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.MethodsConsecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke.ResultsA total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01–11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3–5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52–1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81–3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15–1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45–7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15–0.85, p = 0.02).ConclusionsThis analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR.Visual overviewA visual overview is available for this article.Registrationhttps://www.clinicaltrials.gov; Unique identifier: NCT04968977.