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Cardiovascular disease (CVD) claims millions of lives every year, with atherosclerotic cardiovascular disease (ASCVD) being the main cause. ASCVD treatment includes drug therapy, lifestyle intervention, and Percutaneous Coronary Intervention (PCI) all of which significantly enhance cardiovascular function and reduce mortality. However, hyperplasia can lead to vascular obstruction, worsen angina symptoms, or even cause heart disease, affecting patients' long-term prognosis. Therefore, finding effective ways to combat hyperplasia is crucial for cardiovascular therapy. In recent years, ferroptosis has gained attention as a new form of cell death closely associated with several diseases, including cardiovascular diseases. It involves complex metabolic processes critical for cellular homeostasis and normal function. Abnormal proliferation and phenotypic transformation of vascular smooth muscle cells (VSMC) are crucial mechanisms underlying cardiovascular disease development. Inhibiting ferroptosis in VSMC has the potential to significantly reduce neointima proliferation. Glucagon-like peptide-1 receptor agonist (GLP-1RA) constitutes a widely employed class of hypoglycemic agents with direct implications for the cardiovascular system, mitigating adverse cardiovascular events. Research indicates that the stimulation of GLP-1 holds promise as a therapeutic strategy in mitigating cardiovascular events such as restenosis. Hence, investigating the potential of GLP-1RA as a treatment option for cardiovascular ailments carries immense clinical significance. [ABSTRACT FROM AUTHOR]

Purpose: Obstructive sleep apnea (OSA) is a common disease in patients with coronary artery disease (CAD). Approximately 40–80% of cardiovascular disease patients have obstructive sleep apnea. The manifestation of it can vary significantly in different types of CAD patients. This systematic review and meta-analysis investigate the prevalence and severity of OSA in patients with acute coronary syndrome (ACS). Methods: This systematic review was conducted according to PRISMA guidelines. The first inclusion criteria were that a reliable sleep study had to be done after treating the patients’ acute coronary incident. All patients in the studies included were adults suffering from an ACS who underwent either coronary artery bypass grafting surgery (CABG), a percutaneous coronary intervention (PCI) or had no invasive coronary intervention done. A search was conducted within four valid databases 27.1.2023 and all suitable articles published after 1.1.2010 were included. Results: Eight studies fulfilled the full inclusion criteria. In five of them, a sleep study had been performed after PCI, in two after no coronary intervention, and in one study after CABG. Mean AHI in no-OSA group after PCI was 9.5 /h (95% CI 5.3–13.7) and in the no intervention group 6.4 /h (95% CI 3.5–9.4). In OSA patients, mean AHI after PCI was 34.9 /h (95% CI 25.9–43.8) vs. 24.1 /h without intervention (95% CI 15.6–32.6). Conclusions: Sleep apnea is very common among ACS patients and should be screened for and addressed after the acute coronary intervention. Moreover, we found that OSA is more severe in patients in whom PCI for ACS was indicated as opposed to patients who underwent no coronary intervention. [ABSTRACT FROM AUTHOR]

Introduction: Cilostazol has been widely used to prevent peripheral vascular events after PCI. However, guidelines in cilostazol-based triple antiplatelet therapy for patients with ischemic heart disease undergoing PCI remain unclear. The purpose of this study was to assess the efficacy and safety of DAPT (aspirin and clopidogrel) compared to cilostazol -based TAPT (aspirin, clopidogrel and cilostazol). Methods: We conducted a comprehensive search of the Medline, Embase, Scopus, Cochrane, and Web of Science databases until November 2024 to identify RCTs comparing DAPT with cilostazol -based TAPT in patients with ischemic heart disease undergoing PCI. Pooled risk ratios (RRs) with 95% CIs were calculated. Results: Eight RCTs (5,299 patients) were included in this systematic review and meta-analysis. A significantly reduced risk of all-cause mortality in hospital was observed with DAPT compared to cilostazol -based TAPT (RR: 0.27, 95% CI: 0.07 to 0.94, p = 0.04). Also, A significantly reduced risk of headache and palpitation was observed with DAPT compared to cilostazol -based TAPT, with pooled RR (RR: 0.15, 95% CI: 0.06 to 0.33, p < 0.001) and (RR: 0.24, 95% CI: 0.08 to 0.73, p = 0.01), respectively. However, no difference was observed between DAPT and cilostazol -based TAPT on vessel revascularization, stroke, stent thrombosis, myocardial infarction and major adverse cardiac events. Conclusion: Aspirin and clopidogrel were associated with a lower risk of adverse events compared to cilostazol-based TAPT. However, the addition of cilostazol did not improve clinical outcomes. Further trials are needed to clarify the role of cilostazol -based TAPT for patients with ischemic heart disease undergoing PCI. [ABSTRACT FROM AUTHOR]

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Objective: To study the effect of heart-collateral-based enlightenment words intervention on anxiety and depression in patients following percutaneous coronary intervention (PCI). Methods: In this class experimental study, one hundred patients who were hospitalized after PCI from May 2020 to October 2021, were included in this interventional study. They were divided into the test group (n = 50) and the control group (n = 50) based on the random number table. The heart-collateral-based enlightenment words intervention was used in the test group versus routine nursing in the control group. Data was collected using a self-rating anxiety scale (SAS), self-rating depression scale (SDS), and an independently developed satisfaction questionnaire. Psychological indicators and satisfaction were compared between the two groups before and after the intervention. Results: After 3 months of intervention, the test group scored significantly lower in SDS and SAS than the control group (SDS score: [55.06 ± 8.63] vs. [62.90 ± 9.52]; SAS score: [46.83 ± 10.24] vs. [56.02 ± 8.92]) (P < 0.05 for both SDS and SAS difference). The satisfaction rate of the test group vs. control group was 96% vs. 82% after the intervention, with a statistically significant difference (P < 0.05). Conclusion: Heart-collateral-based enlightenment words intervention can effectively alleviate anxiety and depression in patients after PCI and increase their satisfaction with nursing services. To develop the theory and guide clinical practice, future research in different treatment area with larger sample size should be conducted. [ABSTRACT FROM AUTHOR]

Revascularization therapies, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), alleviate symptoms and treat myocardial ischemia. Patients with multivessel disease, particularly those undergoing 3-vessel PCI, are more susceptible to procedural complications, which can increase healthcare costs. Developing efficient strategies for resource allocation has become a paramount concern due to tightening healthcare budgets and the escalating costs of treating heart conditions. Therefore, it is essential to develop an evaluation model to estimate the costs of PCI surgeries and identify the key factors influencing these costs to enhance healthcare quality. This study utilized the National Health Insurance Research Database (NHIRD), encompassing data from multiple hospitals across Taiwan and covering up to 99% of the population. The study examined data from triple-vessel PCI patients treated between January 2015 and December 2017. Additionally, six machine-learning algorithms and five cross-validation techniques were employed to identify key features and construct the evaluation model. The machine learning algorithms used included linear regression (LR), random forest (RF), support vector regression (SVR), generalized linear model boost (GLMBoost), Bayesian generalized linear model (BayesGLM), and extreme gradient boosting (eXGB). Among these, the eXGB model exhibited outstanding performance, with the following metrics: MSE (0.02419), RMSE (0.15552), and MAPE (0.00755). We found that the patient’s medication use in the previous year is also crucial in determining subsequent surgical costs. Additionally, 25 significant features influencing surgical expenses were identified. The top variables included 1-year medical expenditure before PCI surgery (hospitalization and outpatient costs), average blood transfusion volume, ventilator use duration, Charlson Comorbidity Index scores, emergency department visits, and patient age. This research is crucial for estimating potential expenses linked to complications from the procedure, directing the allocation of resources in the future, and acting as an important resource for crafting medical management policies. [ABSTRACT FROM AUTHOR]

The 2024 European guideline recommendations on coronary revascularization have been endorsed by multiple societies, emphasizing the importance of evidence-based guidelines and multidisciplinary collaboration in patient care. The guidelines address concerns raised by global professional societies regarding the downgrade of CABG recommendations in previous guidelines, providing recommendations for revascularization in patients with 3-vessel disease and diabetes. The document advocates for a Heart Team approach and emphasizes the importance of patient risk profiles and informed preferences in decision-making. [Extracted from the article]

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is necessary for preventing stent thrombosis and ensuring long-term cardiovascular protection. It is important to be thoughtful in balancing thrombotic and bleeding risk when deciding therapy regimen and duration. Revascularization randomized trials have studied many specific, at-risk populations; however, women remain underrepresented. Although there is evidence to support shortened DAPT duration in women, especially those at higher bleeding risk or on chronic oral anticoagulation, we need trials specifically enrolling and focusing on women. [ABSTRACT FROM AUTHOR]

The Medina classification separates true bifurcation lesions into three unnecessary groups: 1.1.1, 1.0.1, and 0.1.1. Non-true bifurcation lesions are divided into three unnecessary subgroups called 0.0.1, 0.1.0, and 1.0.0. Furthermore, the Medina classification does not describe any other important features of a given bifurcation lesion, making it useless when comparing complex bifurcation lesions. This has led to confusion in clinical settings and stagnation of bifurcation research. The Movahed bifurcation classification has overcome those problems by summarizing all true bifurcation lesions into one simple relevant category called B2 (B for bifurcation, 2 meaning both main and side branches at bifurcation site have significant lesions) and non-true bifurcation lesions into two simple categories called B1m (B for bifurcation, 1 m meaning only the main branch has significant lesion) and B1S lesions (B for bifurcation and 1 s meaning only the side branch has significant lesion). Moreover, at the same time, additional unlimited suffixes can be added if needed to describe a given bifurcation lesion, making this bifurcation also very comprehensive. In this perspective, the shortcomings of the Medina classification compared to the Movahed classification are discussed in detail. Plain Language Summary Coronary bifurcation lesion means that coronary trees have significant disease at the site of two coronary branches. This perspective discusses the Movahed classification, which is easier to remember and is more comprehensive in describing atherosclerotic disease involvement of a given coronary bifurcation disease compared to the Medina classification. [ABSTRACT FROM AUTHOR]

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Background and Aims The optimal revascularization strategy in patients with ischaemic cardiomyopathy remains unclear with no contemporary randomized trial data to guide clinical practice. This study aims to assess long-term survival in patients with severe ischaemic cardiomyopathy revascularized by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons and Melbourne Interventional Group registries (from January 2005 to 2018), patients with severe ischaemic cardiomyopathy [left ventricular ejection fraction (LVEF) <35%] undergoing PCI or isolated CABG were included in the analysis. Those with ST-elevation myocardial infarction and cardiogenic shock were excluded. The primary outcome was long-term National Death Index–linked mortality up to 10 years following revascularization. Risk adjustment was performed to estimate the average treatment effect using propensity score analysis with inverse probability of treatment weighting (IPTW). Results A total of 2042 patients were included, of whom 1451 patients were treated by CABG and 591 by PCI. Inverse probability of treatment weighting–adjusted demographics, procedural indication, coronary artery disease extent, and LVEF were well balanced between the two patient groups. After risk adjustment, patients treated by CABG compared with those treated by PCI experienced reduced long-term mortality [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.45–0.79, P =.001] over a median follow-up period of 4.0 (inter-quartile range 2.2–6.8) years. There was no difference between the groups in terms of in-hospital mortality [adjusted odds ratio (aOR) 1.42, 95% CI 0.41–4.96, P =.58], but there was an increased risk of peri-procedural stroke (aOR 19.6, 95% CI 4.21–91.6, P <.001) and increased length of hospital stay (exponentiated coefficient 3.58, 95% CI 3.00–4.28, P <.001) in patients treated with CABG. Conclusions In this multi-centre IPTW analysis, patients with severe ischaemic cardiomyopathy undergoing revascularization by CABG rather than PCI showed improved long-term survival. However, future randomized controlled trials are needed to confirm the effect of any such benefits. [ABSTRACT FROM AUTHOR]

There is a growing global interest in preserving transportation infrastructure. This necessitates routine evaluation and timely maintenance of road networks. The effectiveness of pavement management systems (PMSs) heavily relies on accurate pavement deterioration models. However, there are limited comparative studies on modeling approaches for rural roads in arid climatic conditions using the same datasets for training and testing. This study compares three approaches for developing a pavement condition index (PCI) model as a function of pavement age: classical regression, machine learning, and deep learning. The PCI is a pavement management index widely adopted by many road agencies. A dataset on pavement age and distress was collected over a twenty-year period to develop reliable predictive models. The results demonstrate that the regression model, machine learning model, and the deep learning model achieved a coefficient of determination ( R 2 ) of 0.973, 0.975, and 0.978, respectively. While these values are technically equal, the average bias for the deep learning model (1.14) was significantly lower than that of the other two models, signaling its superiority. Additionally, the trend predicted by the deep learning model showed more distinct phases of PCI deterioration with age than the machine learning model. The latter exhibited a wider range of PCI deterioration rates over time compared to the regression model. The deep learning model outperforms a recently developed regression model for a similar region. These findings highlight the potential of using deep learning to estimate pavement surface conditions accurately and its efficacy in capturing the PCI-age relationship. [ABSTRACT FROM AUTHOR]

Shao-Bing Yang,1 Hong-Wei Zhao2 1Department of Cardiology, The General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China; 2Department of Cardiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, People’s Republic of ChinaCorrespondence: Hong-Wei Zhao, Email zhaohongwei@sysush.comBackground: Inflammation was associated with the increased risk of atrial fibrillation (AF). As a novel inflammatory indicator, albumin/neutrophil-to-lymphocyte ratio score (ANS) has been demonstrated to associate with coronary artery disease. However, the relationship between ANS and new onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) underwent PCI was not determined.Methods: A total of 2410 AMI patients underwent PCI were consecutively included between March 2020 and December 2023. Patients were divided into NOAF group and control group according to the occurrence of NOAF during hospitalization. The ANS was calculated and analyzed, so as to determine its predictive value in the presence of NOAF in AMI patients after PCI.Results: In total, 88 (3.7%) individuals developed NOAF during hospitalization. We found that NOAF was associated with older age, greater LA, higher NT-proBNP, ANS and Killip ≥ 2. The ANS exhibited an accurately predictive value for the NOAF (area under the curve [AUC], 0.695; 95% CI, 0.649– 0.740, P < 0.001). Moreover, when divided into three groups according to the tertile of ANS, patients in tertile 1 (lowest in ANS) showed a 2.214-fold increased risk of NOAF in comparison to those in the tertile 3 (HR, 2.214; 95% CI 1.804– 5.101; P = 0.029).Conclusion: ANS is a robust tool for the prediction of NOAF in AMI patients underwent PCI. Therefore ANS could be used for risk prediction and optimal management for NOAF in AMI patients after PCI.Keywords: albumin/neutrophil-to-lymphocyte ratio score, new-onset atrial fibrillation, acute myocardial infarction, PCI

The Board of the European Society of Cardiology initiated the European Unified Registries On Heart Care Evaluation and Randomized Trials (EuroHeart) program in 2019. It was proposed to establish international cooperation involving national registers using a uniform nomenclature and data structure. The Board of the Hungarian Society of Cardiology joined the program in 2021, which was made possible by the Hungarian Myocardial Infarction Registry (HUMIR), which has been operating continuously since 2014. In the first analysis of the EuroHeart data, 40,021 patients registered for acute myocardial infarction (18,686 STEMI and 21,335 NSTEMI) treated in 2022 in 7 countries (Estonia, Iceland, Hungary, Portugal, Romania, Sweden, Singapore) were included. The data was published in 2023. Nationwide myocardial infarction registers operated in Sweden and Hungary, while regional or centre-specific data were analysed in the other countries. 39.3% of the cases analysed came from Sweden, 30.1% from Hungary, and 20.1% from Portugal. The average age is 68 years, and almost a third of the patients (31.6%) are women. Common comorbidities were hypertension and diabetes (67.9% and 28%, respectively). One in five patients (20.2%) had a history of heart attack, 6.2% had a stroke. Abnormal kidney function was confirmed in 7.5% of patients. According to data from registries covering the entire population, the frequency of PCI treatment in STEMI was 86.2% in Hungary and 91.8% in Sweden. Primary PCI treatment for STEMI patients at the optimal time (

Background/Objectives: Few studies have analyzed in-hospital complications and events following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures for patients who underwent these interventions for single-vessel coronary artery disease (CAD). This study aims to compare the outcomes of PCI and CABG in such patients using a large propensity-matched real-world database based on procedural codes. Methods: Adult patients receiving PCI or CABG for single-vessel CAD were identified from the 2016–2020 National Inpatient Sample (NIS) database. Any cases targeting multi-vessel disease or employing a multi-treatment approach were excluded using appropriate procedural codes. Differences in events and complications from admission to discharge were studied between the two procedures (PCI vs. CABG) via logistic regression analysis. Results: After propensity matching with 273,380 patients in both groups, complication risks such as cardiac tamponade (aOR: 3.6 [3.27–3.96]), acute kidney injury (aOR: 1.53 [1.51–1.56]), cardiogenic shock (aOR: 1.38 [1.34–1.40]), procedural bleeding (aOR: 1.75 [1.67–1.83]), acute ischemic stroke (aOR: 1.89 [1.80–1.97]), and all-cause mortality (aOR: 1.05 [1.02–1.08]) were higher among CABG patients. No differences were observed for events of cardiac perforation (aOR: 0.92, [0.84–1.01]). Conclusions: In this large real-world propensity-matched analysis, CABG was associated with higher risks of multiple in-hospital complications and all-cause mortality compared to PCI following a single-vessel coronary intervention.

Abstract Objective Dual‐antiplatelet therapy (DAPT) and proton pump inhibitor (PPI) are frequently prescribed after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) placement. However, studies that evaluate the optimal PPI when used as primary prevention in patients without a history of peptic ulcer disease or upper gastrointestinal bleeding (UGIB), particularly in the context of DAPT involving prasugrel, are lacking. This study aimed to assess the efficacy and safety of PPI use in preventing UGIB in this patient population. Methods This study included patients who underwent PCI with coronary stent placement for acute coronary syndrome or stable angina at our institution from January 2015 to December 2020. Eligible patients started DAPT with aspirin and prasugrel and concomitantly received PPI therapy (lansoprazole or esomeprazole), with a follow-up period of two years. The primary endpoint was UGIB incidence, diagnosed during follow-up, serving as an efficacy measure. Secondary endpoints included the assessment of major bleeding (as defined by the Thrombolysis in Myocardial Infarction major bleeding criteria) and clinically relevant non-major bleeding events. Safety outcomes focused on adverse event incidence attributable to PPI use. Results Among the 165 patients analyzed, 109 and 56 were included in the lansoprazole and esomeprazole groups, respectively, with cumulative incidence of UGIB at 96 weeks of 0.9% (1/109) and 3.6% (2/56). No significant differences in terms of major bleeding events or other bleeding outcomes were observed between the two groups. Adverse events related to PPI use were reported as diarrhea/soft stools in 7 (6%) cases and thrombocytopenia in 1 (1%) case in the lansoprazole group, whereas no such events were observed in the esomeprazole group. No clinically significant hematologic or biochemical abnormalities were reported. Conclusion This study evaluated the efficacy and safety of PPIs in combination with DAPT, including prasugrel, following PCI, and suggests that lansoprazole and esomeprazole may offer comparable efficacy in preventing UGIB.

Abstract Background Participation in cardiac rehabilitation is low in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Although existing rehabilitation methods have achieved certain results, patient participation in exercise rehabilitation is not ideal. The Patient Health Engagement (PHE) model is designed to ensure that patients improve their participation in cognitive, emotional, behavioral, and other aspects in all phases of exercise rehabilitation. The purpose of this study is to confirm whether the rehabilitation method based on the PHE model improves the rate of patient participation and enhances the rehabilitation effect during cardiac rehabilitation in patients with acute myocardial infarction compared with the traditional rehabilitation model. Methods/design This is a single-center, double-blind, randomized, controlled trial that will enroll 128 patients. Patients with stable acute myocardial infarction after undergoing PCI who received cardiac rehabilitation and postoperative LVEF ≥ 40%, categorized into Killip class I ~ II and with age ≥ 18 years, will be included in the study. Exclusion criteria are mainly malignant arrhythmias, acute heart failure, congestive heart failure, and patients requiring intra-aortic balloon counterpulsation. Patients will be randomized in a 1:1 ratio to the intervention (1) and control (2) groups. Physicians, rehabilitation specialists, patients, and data collectors will be blinded during the study. A rehabilitator and a specialist nurse will conduct the cardiac rehabilitation. The specialist nurse will hand over the sealed bag containing patient information (group 1 or 2) to the physician. Group 1 will undergo cardiac rehabilitation through the PHE model, three times a week for 3 months. The rehabilitation program will be evaluated and adjusted in time from each period of the rehabilitation. Group 2 will be treated with routine cardiac rehabilitation. The rehabilitation participation rate of the two groups will be evaluated before and after 3 months of intervention. The primary outcome will be the level of patient participation in rehabilitation, and the secondary outcome will include general data of patients, postoperative rehabilitation indicators, cardiac rehabilitation knowledge–attitude–practice questionnaire, cardiovascular adverse events, and a brief mood scale. Expected outcomes We expect improved cardiac rehabilitation participation rates and rehabilitation outcomes in patients with acute myocardial infarction after undergoing PCI using the PHE model. Discussion This approach may increase patient participation in rehabilitation, improve rehabilitation outcomes, and be widely implemented in hospitals and rehabilitation centers. Trial registration ClinicalTrials.gov identifier, ChiCTR2400085276 (Version 2.0 June 04, 2024), https://www.chictr.org.cn . Trial sponsor Shandong Second Medical university, Weifang, Shandong. Contact name: Dechun Qin, Address: Shandong Second Medical university, Weifang Shandong. Email: 13562666589@163.com.

Abstract Background Drug-coated balloons (DCB) have promising results in the management of in-stent restenosis (ISR), still their role remains a major challenge, and not well established in contemporary clinical practice. Aims To provide a comprehensive appraisal of the efficacy and safety of DCBs in patients with in-stent restenosis (ISR). Methods We searched PubMed, Scopus, web of Science, Ovid, and Cochrane Central from inception until 30 March, 2023. We included randomized controlled trials (RCTs) that compared DCB versus DES in ISR patients. Our primary endpoints were major adverse cardiac events (MACE) and late lumen loss (LLL). Secondary clinical endpoints were all-cause death, cardiac death, MI, TLR, TVR, and stent thrombosis, and angiographic outcomes were MLD, and in-stent binary restenosis. Results Ten RCTs comprising 1977 patients were included in this meta-analysis. The incidence of MACE was 15.57% in the DCB group compared to 14.13% in the DES group, with no significant difference in the risk of MACE following DCB (odds ratio [OR] 1.04, 95% confidence interval [CI]: 0.87 to 1.44). Compared with the DES intervention, the risk of LLL was comparable to the DCB intervention (mean difference [MD] -0.08, 95% CI: -0.18 to 0.02), while the incidence of TLR was increased in the DCB intervention (OR: 1.54, 95% CI: 1.2 to 1.99). Conclusion DCB was comparable to DES implantation is ISR patients regarding clinical outcomes, however it showed an increase in TLR events. Moreover, a RCT with large sample size and longer follow-up duration is warrened to validate these results.

Abstract Purpose The conundrum of limited resources in developing countries leads to the abonnement and underutilization of percutaneous coronary intervention for chronic total occlusion, in addition to lack of expertise, limited supplies, and success rates. We embraced this challenge by initiating a dedicated program in a tertiary academic center in Egypt, aiming for optimum utilization of resources, limit cost, and gaining experience. We present our outcomes and the proficiency in establishing the program. Methods We enrolled all patients undergoing percutaneous coronary intervention for chronic total occlusion during the first year of initiating our dedicated program. Analysis of clinical data, angiographic findings, and procedural features were evaluated, aiming to evaluate outcomes. Our primary outcome was successful recanalization achievement, utilization of available resources and cost. Secondary outcomes such as peri-procedural myocardial infarction, coronary perforation, urgent need of coronary artery bypass grafting, cerebrovascular stroke, and mortality were assessed. Results Our study enrolled 64 patients electively admitted to the Critical Care Department, Cairo University, undergoing percutaneous coronary intervention for chronic total occlusion. The median J-CTO score was 2 (0–5). We achieved successful recanalization in 47 patients (73%). The mean procedural time was 123 ± 48.8 min, mean contrast volume was 359.03 ± 151.9 ml, and mean radiation dose was 9.4 ± 4.2 Gy. The mean number of wires per patient was 2.69 ± 1.32, and the most successful crossing strategy was antegrade wiring (56.3%). The commonest cause of failure was failure of re-entry (46.7%). One patient had peri-procedural MI (1.6%), and one patient required urgent CABG. There was no in-hospital mortality or cerebrovascular stroke. The cost ranged from 6520 Egyptian Pounds (EP) ($415) to 63,720 EP ($4058), with a mean of 26,213 EP ($1670). Conclusions Establishing a dedicated program for percutaneous coronary intervention for chronic total occlusion proved to be feasible and proficient, achieving high success rates with limited complications in view of limited resources, rationalized utilization of equipment, and limitation of hospital costs.

Acute coronary syndrome (ACS) is one of the most common leading global causes of mortality, encompassing ST‐segment elevation myocardial infarction (STEMI), non‐ST‐segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Percutaneous coronary intervention (PCI) has become a pivotal therapeutic approach for ACS, underscoring the importance of anticoagulation strategies. Among the commonly employed anticoagulants in PCI, heparin and bivalirudin take precedence, with heparin serving as the archetypal choice. Nevertheless, the determination of an optimal anticoagulation regimen remains a point of contention in contemporary clinical practice. To address the differences in anticoagulants during PCI, we meticulously conducted a literature review through PubMed and Web of Science, employing search terms such as "heparin," "bivalirudin," "percutaneous coronary intervention," and "acute coronary syndrome." For patients with PIC brought on by STEMI, NSTEMI, and stable or UA pectoris, the review focused on randomized controlled trials to assess and compare the efficacy and safety of heparin and bivalirudin as anticoagulant options. This systematic review is aimed at furnishing valuable insights into the ongoing debate surrounding the choice of anticoagulation regimens in PCI. By scrutinizing clinical evidence derived from relevant trials, we seek to inform and guide healthcare practitioners in making informed decisions based on the unique requirements of patients with various ACS presentations. [ABSTRACT FROM AUTHOR]

Background Percutaneous coronary intervention (PCI) is the preferred reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI). A delay may lessen the benefits of PCI, whereas early intervention improves both short- and long-term outcomes. Aim The aim of this study was to assess the clinical profile and outcomes in patients presenting with STEMI and undergoing primary PCI at a tertiary care center in Uttar Pradesh (India) Methods The demographics, clinical presentation, details of the procedure, and outcomes of 310 consecutive STEMI patients who underwent PCI at a tertiary care facility in North India were examined in retrospective manner. All patient's received care according to the standard primary PCI protocol. Results The patients' mean age was 57.2±12.6 years. The average duration for chest pain was 230.3±186.2 minutes. The following were risk factors: smoking (24.5%), diabetes mellitus (25.5%), hypertension (24.8%), and a family history of coronary artery disease (CAD; 9.7%). Anterior wall myocardial infarction affected almost half of the patients (AWMI). 47 minutes was the median door to ballooning (DTB) time. In total, complications were experienced by 29 out of 310 individuals. Out of 310 patients, eleven had passed away (3.5%). Conclusion In the Indian context, primary PCI is useful for managing STEMI. Recommendation DTB can still be met even in cases where STEMI patients are not brought to a cardiac intervention clinic right away, which is crucial for improving the results of the intervention. The study also demonstrates that, in comparison to the Western population, STEMI prevalence is more in younger population in India. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit‐only revascularization (COR) in patients with ST‐elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA/ACC/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta‐analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults ≥75 years old.We searched the literature from inception to October 21, 2023. RCTs of CR versus COR in STEMI were selected if it reported results for older adults, defined as either age > 65 years or > 75 years. Integrated hazard ratios (HRs) were calculated using random effects models. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were major bleeding and contrast‐associated acute kidney injury (CA‐AKI).In this meta‐analysis of 5 RCTs including 3513 older adults, CR was associated with a lower hazard of MACE than COR (HR 0.60, 95% CI 0.37–0.99, p = 0.047). Sensitivity analysis including trials that defined older adults as age > 65 years resulted in a lower hazard of MACE with CR versus COR, but not in trials that defined older adults as age > 75 years. There was no difference in the hazard of major bleeding or CA‐AKI between CR and COR.In this largest meta‐analysis to date investigating CR compared with COR in older adults with STEMI, CR was associated with reduced MACE without a concomitant increase in major bleeding or CA‐AKI compared with COR. These results can help cardiologists and geriatricians involved in shared decision‐making with patients and caregivers when contemplating whether to pursue CR in older adults. [ABSTRACT FROM AUTHOR]

Background: As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12 months. Objective: To assess the efficacy and safety of brief DAPT (up to 3 months) succeeded by ticagrelor monotherapy compared with a 12-month DAPT in ACS patients following PCI. Methods: We systematically searched Cochrane, Embase, and PubMed to find relevant randomized clinical trials. Examined outcomes included the incidence of major adverse cerebrovascular and cardiovascular events (MACCE), bleeding events, and the composite incidence of net adverse clinical events (NACE). Results: Our primary analysis included 21,927 ACS patients from six RCTs. Our pooled results indicate that following PCI in individuals with ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE (OR 0.92, 95% CI 0.79–1.07) but significantly reduced the risk of minor or major bleeding (OR 0.52, 95% CI 0.44–0.62) and NACE (OR 0.71, 95% CI 0.59–0.86) compared with a long-term DAPT within a follow-up of 12 months. Conclusion: Brief DAPT followed by ticagrelor monotherapy is superior to a 12-month DAPT in offering a net clinical advantage in ACS patients following PCI. [ABSTRACT FROM AUTHOR]

[Display omitted] Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD. [ABSTRACT FROM AUTHOR]

Background/Objectives: Few studies have analyzed in-hospital complications and events following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures for patients who underwent these interventions for single-vessel coronary artery disease (CAD). This study aims to compare the outcomes of PCI and CABG in such patients using a large propensity-matched real-world database based on procedural codes. Methods: Adult patients receiving PCI or CABG for single-vessel CAD were identified from the 2016–2020 National Inpatient Sample (NIS) database. Any cases targeting multi-vessel disease or employing a multi-treatment approach were excluded using appropriate procedural codes. Differences in events and complications from admission to discharge were studied between the two procedures (PCI vs. CABG) via logistic regression analysis. Results: After propensity matching with 273,380 patients in both groups, complication risks such as cardiac tamponade (aOR: 3.6 [3.27–3.96]), acute kidney injury (aOR: 1.53 [1.51–1.56]), cardiogenic shock (aOR: 1.38 [1.34–1.40]), procedural bleeding (aOR: 1.75 [1.67–1.83]), acute ischemic stroke (aOR: 1.89 [1.80–1.97]), and all-cause mortality (aOR: 1.05 [1.02–1.08]) were higher among CABG patients. No differences were observed for events of cardiac perforation (aOR: 0.92, [0.84–1.01]). Conclusions: In this large real-world propensity-matched analysis, CABG was associated with higher risks of multiple in-hospital complications and all-cause mortality compared to PCI following a single-vessel coronary intervention. [ABSTRACT FROM AUTHOR]

The unexpected population increase in megacities has caused the urban heat island (UHI) effect. The Park Cooling Intensity (PCI) effect offers natural cooling from urban parks that can balance UHI. Doubling the urban population in the next two decades is expected to cause a rise in high-rise buildings. This research thoroughly evaluates the knowledge accumulated by adopting a Systematic Literature Review (SLR) since 2000 regarding the relationship between UHIs and PCI. To identify experimental trends, methodological trends, geographical interdependence, and research gaps in UHI mitigation, results obtained from 9 nations and 11 Köppen-Geiger climate zones are examined and compared from 55 selected research papers. Five significant topics are used to guide a thorough content analysis. The first section of the manuscript enlists identified factors of UHI mitigation affecting urban heat. The second section presents an observation table about how the different researchers have amalgamated the above-discussed factors to infer the comparison among the discussed literature. The study has identified three prominent research gaps explaining limitations in research: 1) current research trends, 2) governing factors of socio-economic and environmental aspects, and 3) exploration of evapotranspiration rates in terms of Bowen ratio. This review will aid researchers in selecting coping mechanisms for urban climates of extreme heat. [ABSTRACT FROM AUTHOR]

Background: Decreases in symptom load and improvements in quality of life are important goals in the invasive treatment of symptomatic chronic coronary syndrome (CCS). To date, it is not known which patients profit most from the invasive treatment. Methods: This sub-analysis of the prospective, multi-centre PLA-pCi-EBO trial includes 145 patients with symptomatic CCS and successful PCI. The prespecified endpoints angina pectoris and quality of life (Seattle Angina Questionnaire–SAQ) were assessed 1 and 6 months after PCI. Predictors of symptom improvement were analyzed by logistic regression analysis. Results: Quality of life, physical limitation, and angina frequency markedly improved 6 months after PCI. Worse baseline health status (i.e., low SAQ subscales) was the best predictor of highly clinically relevant improvements (≥ 20 points in SAQ subscales) in symptom load and quality of life. Demographic factors (age, sex, body-mass index) and cardiovascular disease severity (number of involved vessels, ejection fraction) did not predict relevant improvements after PCI. The influence of psychologic traits has not previously been assessed. We found that neither optimism nor pessimism had a relevant effect on symptomatic outcome. However, patients who exercised more after PCI had a much larger improvement in quality of life despite no differences in physical limitation or angina frequency. Conclusion: PCI effectively reduces symptom load and improves quality of life in patients with symptomatic CCS. Reduced baseline health status (symptom load, quality of life) are the only relevant predictors for improvements after PCI. Physical activity after PCI is associated with greater benefits for quality of life. Trial registry: The German Clinical Trials Register registration number is DRKS0001752. [ABSTRACT FROM AUTHOR]

Roads are essential for economic development, facilitating the circulation of services and resources. This research seeks to provide local governments with a comprehensive framework to enhance road maintenance, focusing on the surface and functional evaluation of pavements. It compares the conventional methods International Roughness Index (IRI) and the Pavement Condition Index (PCI) with novel methodologies that employ smart technologies. The efficiency of such technologies in the maintenance of local roads in Peru is analyzed, taking as a case study a 2 km section of the AR-780 highway in the city of Arequipa. The International Roughness Index (IRI) obtained through the Merlin Roughness Meter and the Roadroid application were compared, finding a minimum variation of 4.0% in the left lane and 8.7% in the right lane. Roadroid turned out to be 60 times faster than the conventional method, with a cost difference of 220.11 soles/km (USD $57.92/km). Both methods classified the Present Serviceability Index (PSI) as good, validating the accuracy of Roadroid. In addition, the Pavement Condition Index (PCI) was evaluated with conventional methods and a DJI Mavic 2 Pro drone, finding a variation of 6.9%. The cost difference between the methodologies was 1047.73 soles/km (USD $275.72/km), and the use of the drone proved to be 10 times faster than visual inspection. This study contributes to closing the knowledge gap regarding the use of smart technologies for better pavement management on local roads, so the actors in charge of such infrastructure make decisions based on science, contributing to the well-being of the population. [ABSTRACT FROM AUTHOR]

Objective: Dual‐antiplatelet therapy (DAPT) and proton pump inhibitor (PPI) are frequently prescribed after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) placement. However, studies that evaluate the optimal PPI when used as primary prevention in patients without a history of peptic ulcer disease or upper gastrointestinal bleeding (UGIB), particularly in the context of DAPT involving prasugrel, are lacking. This study aimed to assess the efficacy and safety of PPI use in preventing UGIB in this patient population. Methods: This study included patients who underwent PCI with coronary stent placement for acute coronary syndrome or stable angina at our institution from January 2015 to December 2020. Eligible patients started DAPT with aspirin and prasugrel and concomitantly received PPI therapy (lansoprazole or esomeprazole), with a follow-up period of two years. The primary endpoint was UGIB incidence, diagnosed during follow-up, serving as an efficacy measure. Secondary endpoints included the assessment of major bleeding (as defined by the Thrombolysis in Myocardial Infarction major bleeding criteria) and clinically relevant non-major bleeding events. Safety outcomes focused on adverse event incidence attributable to PPI use. Results: Among the 165 patients analyzed, 109 and 56 were included in the lansoprazole and esomeprazole groups, respectively, with cumulative incidence of UGIB at 96 weeks of 0.9% (1/109) and 3.6% (2/56). No significant differences in terms of major bleeding events or other bleeding outcomes were observed between the two groups. Adverse events related to PPI use were reported as diarrhea/soft stools in 7 (6%) cases and thrombocytopenia in 1 (1%) case in the lansoprazole group, whereas no such events were observed in the esomeprazole group. No clinically significant hematologic or biochemical abnormalities were reported. Conclusion: This study evaluated the efficacy and safety of PPIs in combination with DAPT, including prasugrel, following PCI, and suggests that lansoprazole and esomeprazole may offer comparable efficacy in preventing UGIB. [ABSTRACT FROM AUTHOR]

Background: Participation in cardiac rehabilitation is low in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Although existing rehabilitation methods have achieved certain results, patient participation in exercise rehabilitation is not ideal. The Patient Health Engagement (PHE) model is designed to ensure that patients improve their participation in cognitive, emotional, behavioral, and other aspects in all phases of exercise rehabilitation. The purpose of this study is to confirm whether the rehabilitation method based on the PHE model improves the rate of patient participation and enhances the rehabilitation effect during cardiac rehabilitation in patients with acute myocardial infarction compared with the traditional rehabilitation model. Methods/design: This is a single-center, double-blind, randomized, controlled trial that will enroll 128 patients. Patients with stable acute myocardial infarction after undergoing PCI who received cardiac rehabilitation and postoperative LVEF ≥ 40%, categorized into Killip class I ~ II and with age ≥ 18 years, will be included in the study. Exclusion criteria are mainly malignant arrhythmias, acute heart failure, congestive heart failure, and patients requiring intra-aortic balloon counterpulsation. Patients will be randomized in a 1:1 ratio to the intervention (1) and control (2) groups. Physicians, rehabilitation specialists, patients, and data collectors will be blinded during the study. A rehabilitator and a specialist nurse will conduct the cardiac rehabilitation. The specialist nurse will hand over the sealed bag containing patient information (group 1 or 2) to the physician. Group 1 will undergo cardiac rehabilitation through the PHE model, three times a week for 3 months. The rehabilitation program will be evaluated and adjusted in time from each period of the rehabilitation. Group 2 will be treated with routine cardiac rehabilitation. The rehabilitation participation rate of the two groups will be evaluated before and after 3 months of intervention. The primary outcome will be the level of patient participation in rehabilitation, and the secondary outcome will include general data of patients, postoperative rehabilitation indicators, cardiac rehabilitation knowledge–attitude–practice questionnaire, cardiovascular adverse events, and a brief mood scale. Expected outcomes: We expect improved cardiac rehabilitation participation rates and rehabilitation outcomes in patients with acute myocardial infarction after undergoing PCI using the PHE model. Discussion: This approach may increase patient participation in rehabilitation, improve rehabilitation outcomes, and be widely implemented in hospitals and rehabilitation centers. Trial registration: ClinicalTrials.gov identifier, ChiCTR2400085276 (Version 2.0 June 04, 2024), https://www.chictr.org.cn. Trial sponsor: Shandong Second Medical university, Weifang, Shandong. Contact name: Dechun Qin, Address: Shandong Second Medical university, Weifang Shandong. Email: 13562666589@163.com. [ABSTRACT FROM AUTHOR]

Background: Drug-coated balloons (DCB) have promising results in the management of in-stent restenosis (ISR), still their role remains a major challenge, and not well established in contemporary clinical practice. Aims: To provide a comprehensive appraisal of the efficacy and safety of DCBs in patients with in-stent restenosis (ISR). Methods: We searched PubMed, Scopus, web of Science, Ovid, and Cochrane Central from inception until 30 March, 2023. We included randomized controlled trials (RCTs) that compared DCB versus DES in ISR patients. Our primary endpoints were major adverse cardiac events (MACE) and late lumen loss (LLL). Secondary clinical endpoints were all-cause death, cardiac death, MI, TLR, TVR, and stent thrombosis, and angiographic outcomes were MLD, and in-stent binary restenosis. Results: Ten RCTs comprising 1977 patients were included in this meta-analysis. The incidence of MACE was 15.57% in the DCB group compared to 14.13% in the DES group, with no significant difference in the risk of MACE following DCB (odds ratio [OR] 1.04, 95% confidence interval [CI]: 0.87 to 1.44). Compared with the DES intervention, the risk of LLL was comparable to the DCB intervention (mean difference [MD] -0.08, 95% CI: -0.18 to 0.02), while the incidence of TLR was increased in the DCB intervention (OR: 1.54, 95% CI: 1.2 to 1.99). Conclusion: DCB was comparable to DES implantation is ISR patients regarding clinical outcomes, however it showed an increase in TLR events. Moreover, a RCT with large sample size and longer follow-up duration is warrened to validate these results. [ABSTRACT FROM AUTHOR]

Background/Objectives: The impact of alcohol consumption and its restriction on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) remains elusive. We aimed to investigate the clinical outcomes in drinkers undergoing PCI. Methods: We included 77,409 patients who underwent PCI and a health check-up within one year of the PCI using a nationwide prospective database from the Korean National Health Insurance System. Primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause mortality, myocardial infarction, coronary revascularization, and stroke. Patients were classified as non-drinkers, within-the-guideline (≤1 standard drink in women and ≤2 in men), and above-the-guideline drinkers based on drinking status at the first health check-up after PCI. Results: During a 4.0-year follow-up duration, MACCE incidence was 19.7% (n = 15,214) (4689 [6.1%] deaths, 1916 [2.5%] MI, 2033 [2.6%] strokes, and 10,086 [13.0%] revascularizations). Both within-the-guideline- (aHR [95%CI], 0.843 [0.773–0.919]) and above-the-guideline drinkers (0.829 [0.784–0.876]) had a lower MACCE risk than the non-drinkers. A characteristic J-curve relationship was observed between the frequency or body weight-adjusted alcohol consumption and MACCE risk, with the lowest risk in the once-per-week and a mild amount per body weight (≤0.33 g/kg/week) group. Drinking habits after PCI were associated with a lower risk of adverse cardiovascular outcomes; those who continued to drink before and after PCI had the lowest risk. Conclusions: Alcohol consumption was associated with a lower risk of adverse outcomes in patients undergoing PCI. Further studies with longer-term follow-up are warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2019, approximately 330 million individuals in China were affected by cardiovascular diseases, with 11.4 million cases specifically attributed to coronary artery disease (CAD). A national public health report indicated that the mortality rate for CAD ranged from 121.59 to 130.14 per 100,000 individuals in 2019. The treatments for CAD include lifestyle changes, medications, percutaneous coronary intervention (PCI) and coronary artery bypass grafting. OBJECTIVE: To investigate the management effect of a digital health program in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). METHODS: This retrospective study compares blood pressure, blood glucose, low-density lipoprotein cholesterol (LDL-C), medication adherence, lifestyle modification, and readmission rate between digital health users and traditional follow-up in post-PCI CAD patients. RESULTS: In this study of 698 CAD patients, the 6-month readmission rate of all patients was 27.4%, with digital health users showing lower rates than those in traditional follow-up (22.6% vs. 32.1%, p = 0.005). Digital health users had significantly higher target achievements rates in blood pressure (79.7% vs. 54.7%, p < 0.001), blood glucose (98.9% vs. 82.5%, p < 0.001) and LDL-C level (71.3% vs. 52.7%, p < 0.001) at 6-month post-PCI. The digital health group had more patients adopting lifestyle changes, including quitting smoking, maintaining a healthy diet, and exercising regularly. In risk factor analysis, digital health utilization (OR = 0.60, 95%CI: 0.40–0.90, p = 0.014) and multivessel disease (double: OR = 1.72, 95%CI: 1.09—2.72, p = 0.02; triple: OR = 2.59, 95%CI: 1.61–4.17, p < 0.001) were independent predictors of CAD-related cardiovascular readmissions. CONCLUSIONS: Post-PCI patients using digital health platforms exhibited improved blood pressure, glucose, and LDL-C control, greater treatment adherence, enhanced lifestyle changes, and reduced six-month readmission rates versus those with traditional follow-up. [ABSTRACT FROM AUTHOR]

This study investigated the effect of ticagrelor combined with nicorandil on endothelial function and coronary blood flow after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). We retrospectively analyzed 300 STEMI patients who underwent emergency PCI, 150 in the observation group and 150 in the control group. The control group was given oral ticagrelor. The observation group received oral nicorandil along with the control group. A significant improvement in peak ejection rate (PER) and left ventricular (LV) ejection fraction (EF) occurred after the operation, while LV end-diastolic volume index (LVESVI), LV end-diastolic internal diameter (LVEDD), cardiac troponin I (cTnI), and creatine kinase myoglobin (CK-MB) were significantly reduced compared to the preoperative period. Improvements in cardiac function were significantly greater in the observation group than in the control group (p < 0.05). After the operation, both groups' serum nitric oxide (NO) and endothelin-1 (ET-1) levels were greatly higher and lower, respectively, during the preoperative period (p < 0.05). The observation group's serum NO level was significantly higher than the control group's, and its ET-1 level was substantially lower than the control group's (p < 0.05). There was a significant increase in thrombolysis in myocardial infarction (TIMI) flow grade 3 percentage and TIMI myocardial perfusion grade (TMPG) grade 3 percentage in the observation group in the immediate postoperative period compared to the control group, despite a significantly lower corrected TIMI Frame count (CTFC) (p < 0.05). 1 month postoperatively, major adverse cardiovascular events (MACE) incidence was significantly lower in the observation group than in the control group (χ2 = 3.914, p = 0.048). The preoperative combination of ticagrelor and nicorandil in STEMI patients undergoing PCI helped attenuate vascular endothelial function impairment, improved coronary blood flow, and promoted postoperative cardiac function recovery. [ABSTRACT FROM AUTHOR]

Background & Objective: Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment elevation myocardial infarction (STEMI), Non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (USA). Patients diagnosed with NSTEMI are either treated conservatively or early invasive strategy is adopted. In NSTEMI it is believed that either one or more vessel is transiently occluded or that the blood flow is critically reduced in a patent vessel i.e. subtotal occlusion. This study was conducted to find the angiographic characteristics of NSTEMI patients undergoing coronary angiography. Methods: This study was conducted in Department of Cardiology, Lady Reading Hospital Peshawar. It was Cross Sectional Study. Data was collected from 8th November 2022 to 8th May 2023. Consecutive non-probability sampling technique was used to collect data from the patients. Results: Total of 300 patients were studied. The mean age was 56.95 years ±1.176 standard deviation. Male patients were 201 (67%) and remaining were female. It was found that 51(17%) of total NSTEMI patients were having totally obstructed coronary artery (OCA) in one or more coronary arteries. In NSTEMI, non-obstructive CAD (<50%) were found in 81 (27%) of patients whereas 219 (73%) were having significant CAD. It was found that 40% were having single vessel CAD, 32% were having double vessel CAD and 28% were having triple vessel CAD. TVCAD was present significantly higher in advance age, Diabetes mellitus, hyperlipidemia and family history of CAD. Conclusion: Patients having NSTEMI are usually having multiple risk factors and having usually severe and multivessel CAD. [ABSTRACT FROM AUTHOR]

Background: Spontaneous coronary artery dissection (SCAD) is a rare and often underdiagnosed cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. The management of SCAD remains a subject of debate, likely secondary to inconclusive evidence. This study aims to compare the clinical outcomes of SCAD patients treated with optimal medical therapy (OMT) versus those who underwent percutaneous coronary intervention (PCI) using a national population-based cohort. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2020. The study included patients identified with SCAD using the ICD-10-CM (the International Classification of Diseases, Tenth Revision, Clinical Modification) code I25.42. We excluded individuals who did not receive PCI or coronary angiography, those who underwent coronary artery bypass grafting, and patients with incomplete records. The primary outcome was in-hospital mortality, while secondary outcomes included acute kidney injury, cardiac arrest, cardiogenic shock, use of temporary mechanical circulatory support, cost of hospitalization, and length of stay. National estimates were obtained using discharge weights, and statistical comparisons were performed using chi-square tests and linear regression. Multivariate logistic regression was employed to identify predictors of mortality and other outcomes. Results: A total of 31,105 SCAD patients were included in the study, with 10,480 receiving OMT and 20,625 undergoing PCI. Patients in the PCI group were older (mean age 64 vs. 54 years) and had higher comorbidities compared to those in the OMT group. The proportion of SCAD patients receiving PCI declined from 72% in 2016 to 60% in 2020. In multivariable analysis, PCI was associated with increased in-hospital mortality (odds ratio (OR) 1.89, 95% confidence interval (CI) 1.24-2.90, p = 0.0003), cardiogenic shock (OR 2.29, 95% CI 1.71-3.07, p < 0.0001), use of a left ventricular assist device (LVAD) (OR 3.97, 95% CI 2.42-6.53, p < 0.0001), and an intra-aortic balloon pump (IABP) (OR 2.24, 95% CI 1.63-3.09, p < 0.0001). Trends also suggested an association between PCI and cardiac arrest, extracorporeal membrane oxygenation (ECMO), and acute kidney injury (AKI). The PCI group had significantly higher hospitalization costs and longer lengths of stay compared to the OMT group (both p < 0.001). Conclusions: In this large, national cohort study, SCAD patients who underwent PCI had significantly higher risks of adverse in-hospital outcomes, including mortality, compared to those treated with OMT. These findings underscore the importance of careful patient selection and the potential advantages of conservative management in SCAD, particularly in patients without severe or unstable presentations. Further research is needed to develop evidence-based guidelines for the optimal management of SCAD. [ABSTRACT FROM AUTHOR]

Introduction: The sheathless transradial (TR) technique is a novel approach that may offer potential benefits over the conventional TR approach. We aim to comprehensively investigate the safety and efficacy of sheathless versus conventional TR percutaneous coronary interventions (PCIs). Methods: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science (WOS), Scopus, and EMBASE until July 2023. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). PROSPERO ID: CRD42023443834. Results: We included 11 studies with 15,392 patients. The radial artery spasm (RAS) (RR: 0.26, 95% CI: [0.09, 0.77], p = 0.02) and cross‐over to the femoral site (RR: 0.28, 95% CI: [0.10, 0.81], p = 0.02) were significantly lower in the sheathless group. However, radial artery occlusion (RAO) (RR: 2.84, 95% CI: [1.78, 4.54], p < 0.0001) and success rate (RR: 1.011, 95% CI: [1.004, 1.019], p = 0.002) were significantly higher in the sheathless group. Also, we did not find a significant difference between both groups in all‐cause mortality (RR: 0.41, 95% CI: [0.16, 1.04], p = 0.06). Conclusion: The sheathless TR approach showed lower rates of RAS and femoral conversion. Sheathless has a higher success rate; however, it also increased RAO. Thus, more trials are needed to confirm this technique's long‐term outcomes and complications. [ABSTRACT FROM AUTHOR]

Elderly patients diagnosed with acute coronary syndromes (ACS) represent a growing demographic population. These patients typically present more comorbidities and experience poorer outcomes compared to younger patients. Furthermore, they are less frequently subjected to revascularization procedures and are less likely to receive evidence-based medications in both the short and long-term periods. Assessing frailty is crucial in elderly patients with ACS because it can influence management decisions, as well as risk stratification and prognosis. Indeed, treatment decisions should consider geriatric syndromes, frailty, polypharmacy, sarcopenia, nutritional deficits, prevalence of comorbidities, thrombotic risk, and, at the same time, an increased risk of bleeding. Rigorous clinical assessments, clear revascularization criteria, and tailored approaches to antithrombotic therapy are essential for guiding personalized treatment decisions in these individuals. Assessing frailty helps healthcare providers identify patients who may benefit from targeted interventions to improve their outcomes and quality of life. Elderly individuals who experience ACS remain significantly underrepresented and understudied in randomized controlled trials. For this reason, the occurrence of ACS in the elderly continues to be a particularly complex issue in clinical practice, and one that clinicians increasingly have to address, given the general ageing of populations. This review aims to address the complex aspects of elderly patients with ACS to help clinicians make therapeutic decisions when faced with such situations. [ABSTRACT FROM AUTHOR]