Evolution of cardiovascular risk factors and the risk for cardiovascular events in a Caucasian population with polycystic ovary syndrome

OBJECTIVE

To estimate the risk of cardiovascular (CV) events (primary aim) and to evaluate the long-term variation in CV risk factors in a Caucasian population of women with polycystic ovary syndrome (PCOS).

DESIGN

Matched cohort prospective study based on 10 years of follow-up.

METHODS

One hundred twenty Caucasian women with PCOS diagnosed by the National Institutes of Health criteria in reproductive age were assessed at baseline (2009) and at the end of follow-up (2020) for major and minor CV events and CV risk factors. Five controls were exactly matched by age and the presence/absence of type 2 diabetes with each participant at baseline (total number = 600) and followed up to evaluate the relative risk of PCOS for CV events. Change in epicardial fat thickness (EFT) was also analysed.

RESULTS

The mean age of patients with PCOS at follow-up was 51.9 ± 7.7 years. No major CV events were detected in PCOS patients (0% vs. 2% among controls), and the incidence of any minor CV events was 4.2% vs. 2.3% among controls (P = .340). The percentage of most CV risk factors (obesity, type 2 diabetes, hypertension, dyslipidaemia, and carotid intima media thickness ≥1 mm with or without plaques with non-critical stenosis) increased. By contrast, both short- and long-axis EFTs and smoking decreased markedly.

CONCLUSIONS

Caucasian patients with PCOS do not have an increased risk for CV events during the late reproductive or early post-menopausal period, despite the increase in most CV risk factors, except for EFT that markedly decreases. Further studies are needed to determine the role of EFT on CV risk in PCOS.

Association of P2RY12 Gene Variants and Non-Genetic Factors With Clopidogrel Responsiveness in Vietnamese Patients After Percutaneous Coronary Intervention: A Cross-Sectional Study

BACKGROUND

Clopidogrel response varies significantly among individuals due to multiple influencing factors. This study aimed to investigate the associations between P2RY12 gene variants, non-genetic factors, and platelet aggregation in patients undergoing clopidogrel therapy and percutaneous coronary intervention.

METHODS

We conducted a cross-sectional descriptive study involving 171 patients who successfully underwent coronary artery stenting and were treated with clopidogrel at two military hospitals in Vietnam. Platelet aggregation was assessed using the light transmission aggregometry (LTA) method, with clopidogrel resistance (CR) defined as maximal platelet aggregation > 50%. P2RY12 genetic polymorphisms (C34T-rs6785930 and G52T-rs6809699) were genotyped using Sanger sequencing.

RESULTS

The allele frequencies were 74.56% (C) and 25.44% (T) for P2RY12 C34T, and 88.30% (G) and 11.70% (T) for P2RY12 G52T. Platelet aggregation progressively increased across the GG, GT, and TT genotypes of P2RY12 G52T (p = 0.03), with patients carrying the TT genotype exhibiting significantly higher platelet aggregation compared to other genotypes (p = 0.01). Among non-genetic factors, proton pump inhibitor (PPI) intake was associated with a significant increase in platelet aggregation (p = 0.03). The prevalence of clopidogrel resistance (CR) was 43.86%. Multivariate logistic regression analysis identified the T allele of P2RY12 C34T, reduced estimated glomerular filtration rate (eGFR), and PPI intake as significant risk factors for CR (OR = 2.24, 2.49, 4.01; p = 0.02, 0.049, 0.01, respectively).

CONCLUSIONS

The T allele of P2RY12 C34T was associated with an increased risk of CR. Among non-genetic factors, PPI intake significantly elevated platelet aggregation and, along with reduced eGFR, contributed to a higher risk of CR.

Effect of Kuanxiong Aerosol on Perioperative Coronary Microcirculation in Patients with Unstable Angina Undergoing Elective PCI: A Pilot Randomized Controlled Trial

OBJECTIVE

To evaluate the immediate effect of Kuanxiong Aerosol (KXA) on perioperative coronary microcirculation in patients with unstable angina (UA) suffering from elective percutaneous coronary intervention (PCI).

METHODS

From February 2021 to July 2023, UA inpatients who underwent PCI alone in the left anterior descending (LAD) branch were included. Random numbers were generated to divide patients into the trial group and the control group at a ratio of 1:1. The index of coronary microcirculation resistance (IMR) was measured before PCI, and the trial group was given two sprays of KXA, while the control group was not given. IMR was measured again after PCI, cardiac troponin I (cTnI) and creatine kinase isoenzyme-MB (CK-MB) were detected before and 24 h after surgery, and major cardiovascular adverse events (MACEs) were recorded for 30 days. The data statistics and analysis personnel were blinded.

RESULTS

Totally 859 patients were screened, and 62 of them were involved into this study. Finally, 1 patient in the trial group failed to complete the post-PCI IMR and was excluded, 30 patients were included for data analysis, while 31 patients in the control group were enrolled in data analysis. There was no significant difference in baseline data (age, gender, risk factors, previous history, biochemical index, and drug therapy, etc.) between the two groups. In addition, differences in IMR, cTnI and CK-MB were not statistically significant between the two groups before surgery. After PCI, the IMR level of the trial group was significantly lower than that of the control group (19.56 ± 14.37 vs. 27.15 ± 15.03, P=0.048). Besides, the incidence of perioperative myocardial injury (PMI) was lower in the trial group, but the difference was not statistically significant (6.67% vs. 16.13%, P=0.425). No MACEs were reported in either group.

CONCLUSIONS

KXA has the potential of improving coronary microvascular dysfunction. This study provides reference for the application of KXA in UA patients undergoing elective PCI. (Registration No. ChiCTR2300069831).

Prognostic value of extracellular volume fraction in myocardial infarction and myocardial infarction with nonobstructive coronary arteries: A multicenter study

RATIONALE AND OBJECTIVES

The aim of the present retrospective study was to evaluate the prognostic role of the extracellular volume fraction (ECV) in patients with myocardial infarction (MI) and myocardial infarction with nonobstructive coronary arteries (MINOCA). The present study hypothesized that ECV is associated with major adverse cardiovascular events (MACEs) in MI and MINOCA patients.

MATERIALS AND METHODS

Cardiac magnetic resonance (CMR) imaging was performed on 351 consecutive patients (mean age: 58 ± 12 years; 252 [71.8%] males) who were diagnosed with MI between October 2015 and November 2023. From CMR imaging, the extent of late gadolinium enhancement (LGE), native T1 and ECV were derived. Patients were categorized into groups according to the degree of coronary artery stenosis, namely, patients with MINOCA and patients with obstructive MI. Follow-up was performed to assess MACEs.

RESULTS

The final cohort consisted of 61 MINOCA patients and 290 obstructive MI patients. During a mean follow-up of 27 ± 16 months, there was no statistically significant difference in the incidence of MACEs between patients with MINOCA and those with obstructive MI, and the two groups of patients had similar ECVs (32.2 ± 3.6 vs. 32.3 ± 6.0, p = 0.864). According to the multivariate Cox regression, ECV was an independent predictor of MACEs (HR: 1.13; p < 0.001) and significantly improved the prognostic value of the baseline multivariate models (C-statistic improvement: 0.816-0.864, p = 0.001). Similarly, ECV maintained an independent association with MACEs in the MINOCA (HR: 1.35; p < 0.001) and obstructive MI (HR: 1.13; p < 0.001) groups.

CONCLUSION

In MI and MINOCA patients, ECV is an independent predictor of MACEs. MINOCA is not a benign disease, and its long-term prognosis is as poor as that of patients with obstructive MI.

Timing of coronary angiography in high-risk non-ST-elevation acute coronary syndrome: results from the Portuguese Registry for Acute Coronary Syndromes (ProACS)

BACKGROUND

Current guidelines recommend an early invasive coronary angiography (ICA) within 24 h of admission for high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Nevertheless, meta-analyses failed to demonstrate a clear advantage of this strategy in reducing hard endpoints such as death or nonfatal myocardial infarction compared to a delayed approach. Thus, the optimal timing of ICA in high-risk NSTE-ACS remains undetermined.

OBJECTIVE

This study aimed to determine the optimal timing for ICA in high-risk NSTE-ACS, regarding 1-year all-cause mortality and cardiovascular rehospitalizations.

METHODS

We conducted a national multicenter retrospective study of high-risk NSTE-ACS patients included in the Portuguese Registry for Acute Coronary Syndromes. Patients were divided into three groups according to the time of ICA: within the first 24 h, between 24 and 48 h, and between 48 and 72 h. The incidence of in-hospital complications and mortality, 1-year mortality, and cardiovascular rehospitalizations were assessed.

RESULTS

Of the 9949 patients included, 46.7% underwent early ICA. This was associated with a lower incidence of acute heart failure (8.5% vs. 11.1% vs. 11.5%, P  < 0.001) and shorter length of stay (3 vs. 4 vs. 6 days, P  = 0.012). It, however, did not reduce in-hospital complications or mortality (1.2 vs. 0.7 vs. 0.8%, P  = 0.066). We also found no significant association with the composite endpoint of 1-year mortality or cardiovascular rehospitalization (15.1 vs. 15.9 vs. 15.7%, P  = 0.887).

CONCLUSIONS

Early ICA was associated with a lower incidence of acute heart failure and shorter length of stay, without a significant impact on 1-year mortality risk or cardiovascular rehospitalizations.

Design and rationale of the South-East Netherlands Heart Registry (ZON-HR)

INTRODUCTION

In patients undergoing percutaneous coronary intervention (PCI), personalised medicine is key to the secondary prevention of ischaemic and bleeding events. To provide an extensive overview of the quality of secondary prevention and of personalised medicine, a consortium in the southeastern region of the Netherlands has created a PCI registry: the South-East Netherlands Heart Registry (Zuid-Oost Nederland Hart Registratie, ZON-HR).

AIM

To visualise and improve personalised secondary prevention post-PCI, focussing on key elements such as antiplatelet treatment, cholesterol management and comorbidities such as diabetes mellitus.

DESIGN AND POPULATION

A prospective multicentre registry of all consecutive patients undergoing PCI at 4 participating PCI centres and 3 referral centres.

TREATMENT

Interventional procedures and concomitant pharmaceutical treatment are performed in accordance with the guidelines. The ZON-HR promotes risk stratification after PCI using a simplified protocol for a personalised antiplatelet strategy.

DATA COLLECTION AND QUALITY

Demographics, laboratory values, baseline procedural characteristics and pharmaceutical treatment data are collected. Outcomes include thromboembolic and bleeding complications and medication changes. Data are pseudonymised, and a clinical event committee will review 20% of the adverse events (randomly selected).

STRENGTHS AND WEAKNESSES

This registry represents the entire PCI population and visualises gaps in secondary prevention. Weaknesses are the collection of outcomes and medication changes using mostly patient-reported outcomes.

CONCLUSION

The ZON-HR is a comprehensive PCI registry that provides baseline and follow-up data of a large PCI cohort in the southeastern region of the Netherlands. The ZON-HR aims to improve secondary prevention after PCI and augment personalised treatment that focusses on key elements of secondary prevention.

Characterization of epicardial adipose tissue thickness and structure by ultrasound radiomics in acute and chronic coronary patients

We hypothesize that epicardial adipose tissue (EAT) structure differs between patients with coronary disease and healthy individuals and that EAT may undergo changes during an acute coronary syndrome (ACS). This study aimed to investigate EAT thickness (EATt) and structure using ultrasound radiomics in patients with ACS, patients with chronic coronary syndrome (CCS), and controls and compare the findings between the three groups. This prospective monocentric comparative cohort study included three patient groups: ACS, CCS, and asymptomatic controls. EATt was assessed using transthoracic echocardiography. Geometrical features (as mean gray value and raw integrated density) and texture features (as angular second moment, contrast and correlation) were computed from grayscale Tagged Image File Format biplane images using ImageJ software. EATt did not significantly differ between the ACS group (8.14 ± 3.17 mm) and the control group (6.92 ± 2.50 mm), whereas CCS patients (9.96 ± 3.19 mm) had significantly thicker EAT compared to both the ACS group (p = 0.025) and the control group (p < 0.001). Radiomics analysis revealed differences in geometrical parameters with discriminatory capabilities between both ACS group and controls and CCS group and controls. A multivariate analysis comparing ACS and CCS patients revealed that differences in EAT characteristics were significant only in patients with a body mass index below 26.25 kg/m². In this subgroup, patients older than 68 exhibited a higher modal gray value (p = 0.016), whereas those younger than 68 had a lower minimum gray value (p = 0.05). Radiomic analysis highlights its potential in developing imaging biomarkers for early diagnosis and coronary artery disease progression monitoring.

Impact of Single Long Stents Versus Overlapping Stents on Clinical Outcomes in Primary PCI

BACKGROUND

Patients with long coronary lesions undergoing primary percutaneous coronary intervention (pPCI) have higher rates of adverse clinical events. Both stent length and stent overlap are associated with worse outcomes; however, data comparing very long stent (VLS) to overlapping stents (OSs) are limited, particularly during pPCI. This study aimed to compare the impact of a single VLS versus ≥2 OSs on clinical outcomes in a multicenter registry of patients undergoing pPCI.

METHODS

This study included patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI using a single VLS (≥38 mm) or ≥2 OS (total stent length, ≥38 mm) in the culprit lesion. After propensity score matching based on tortuosity, calcification, Killip class, culprit lesion length ≥40 mm, and culprit vessel, the final cohort for analysis was selected. The primary endpoint was a combination of mortality and target lesion failure (reinfarction, stent thrombosis, or new revascularization) at 2 years.

RESULTS

Among 647 consecutive STEMI patients who underwent pPCI between March 2016 and September 2022, 353 received VLS and 294 received OSs. After propensity score matching, 264 patients remained (132 in each group). The occurrence of the primary outcome (VLS: 12.9 vs. OS: 15.9%; P = 0.86), all-cause mortality (VLS: 7.6 vs. OS: 9.8%; P = 0.51), and target lesion failure (VLS: 8.3 vs. OS: 6.8, P = 0.64) were similar between the 2 groups.

CONCLUSIONS

In this cohort of real-world patients with STEMI undergoing pPCI, we found no significant difference in outcomes between VLS and OSs. Both strategies are reasonable treatment options for STEMI patients.

Cannabis use and atherosclerotic cardiovascular disease outcomes: A meta-analysis of multinational cohort data

BACKGROUND

While an association between cannabis use and the risk of atherosclerotic cardiovascular diseases (ASCVD) has been reported numerous times, it remains inconclusive as to whether this link is causal in nature. We sought to consolidate data from observational studies to explore the association between ever use of cannabis and ASCVD outcomes, including myocardial infarction, stroke, and a combined measure of any adverse cardiovascular events in comparison to non-users or controls.

METHODS

We performed a systematic literature search on PubMed, Scopus, ScienceDirect, and Cochrane Library for relevant studies from inception until April 2024. Statistical analyses utilized RevMan 5.4 with a random effects model. The study protocol has been registered with PROSPERO (CRD42024530366).

RESULTS

Our analysis incorporated data from 17 studies involving a total of 1,902,481 individuals aged between 18 and 74 years, with a mean follow-up duration of 8.5 years. Upon pooled analysis, no statistically significant association was found between cannabis use and the risk of myocardial infarction compared to non-users, with an RR of 1.25 (95% CI: 0.91-1.71, p = 0.17). Similarly, while the risk of stroke showed no significant association with cannabis use (RR: 1.38, 95% CI: 0.88 to 2.16, p = 0.16), a statistically significant association was observed between ever use of cannabis and the composite of any adverse cardiovascular events (RR: 1.48, 95% CI: 1.16-1.90, p = 0.002).

CONCLUSION

The evident statistical correlations between cannabis use and adverse cardiovascular outcomes underscore its potential as a risk factor for cardiovascular disease, suggesting plausibility for a causal relationship between cannabis use and ASCVD. With rising trends in medical cannabis use and cannabis use disorder across age demographics, heightened risk awareness and informed decision-making regarding cannabis consumption are critical priorities in healthcare and public health initiatives.

Efficacy and Safety of Sirolimus-Coated Balloon Angioplasty in De Novo Lesions in Large Coronary Vessels: A Propensity Score-Matched Study

BACKGROUND

Evidence regarding drug-coated balloon (DCB)-only angioplasty in de novo lesions of large vessels is still limited and mainly focused on paclitaxel-coated balloon. We aimed to analyze the safety and efficacy of sirolimus-coated balloon (SCB)-only angioplasty in de novo lesions in large vessels compared to drug-eluting stent (DES).

METHODS

In this retrospective, dual-center, case-control study, we enrolled all consecutive patients treated between January 2022 and January 2024 with SCB-only angioplasty in de novo lesion in large vessel (> 2.75 mm) compared to a propensity-score matched contemporary population treated with DES. The primary endpoint was the rate of target lesion revascularization (TLR), while secondary endpoints were cardiac death (CD), target vessel revascularization (TVR), myocardial infarction (MI), and target lesion failure (TLF), defined as a composite of them.

RESULTS

The mean age was 70.1 ± 9.8 years in the SCB group (n = 92) and 67.9 ± 9.6 years in the DES group (n = 92) (p = 0.76). The median follow-up was 19.5 ± 12 months in the SCB group and 20.1 ± 13.1 months in the DES group (p = 0.47). TLR occurred in 6.7% of patients in the SCB group and 5.6% in the DES group (p = 0.75). The incidence of MI, TVR, and TLF were similar between the two groups (4.3% vs 3.3%, p = 0.7, 2.2% vs 3.4%, p = 0.65% and 9.8% vs 8.7%, p = 0.79). CD occurred in 4.3% in the SCB group, compared to 3.3% in the DES group (p = 0.70).

CONCLUSION

Our study suggests that SCB angioplasty is both safe and effective in the treatment of de novo lesions of large vessels compared with DES.

Recent advances in biomimetic nanodelivery systems for the treatment of myocardial ischemia reperfusion injury

Myocardial ischemia/reperfusion injury (MIRI) is a significant challenge in the treatment of myocardial infarction, a leading cause of global mortality due to irreversible cardiac damage. Biomimetic nanodelivery systems offer promising therapeutic strategies to address MIRI. In this review, we comprehensively investigate the underlying pathophysiological mechanisms of MIRI and discuss recent advances in biomimetic nanodelivery systems including cell membrane-coated nanoparticles, exosomes, and nanoenzymes as innovative approaches for MIRI treatment. We emphasize the advantages and potential of biomimetic strategies in enhancing therapeutic efficacy, assess the preclinical effectiveness of these nanodelivery systems, and discuss the challenges associated with translating these approaches into clinical practice. This paper aims to provide new perspectives on biomimetic strategies for MIRI treatment, contributing to the development of effective drug delivery systems.

Impact of high bleeding risk and associated risk factors on major adverse cardiovascular or cerebrovascular events in primary percutaneous coronary intervention treated ST-elevation myocardial infarction

BACKGROUND

After percutaneous coronary intervention (PCI), patients at high bleeding risk (HBR) according to The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria have increased risk for ischemic complications. The underlying cause is not well documented. The aim of this study was to assess the ischemic risk among ST-elevation myocardial infarction (STEMI) patients classified as HBR according to the ARC-HBR and to identify individual risk factors.

METHODS

Consecutive STEMI patients treated with primary PCI in a Finnish tertiary hospital between 2016 and 2022 were identified using a database search. Data was collected by reviewing electronic patient records. Bleeding risk was assessed according to the ARC-HBR criteria. The primary endpoint was 1-year major adverse cardiovascular or cerebrovascular event (MACCE).

RESULTS

In total, 1367 STEMI patients were included. Cumulative incidence of MACCE was 19.5 % among HBR and 6.32 % among non-HBR. From the ARC-HBR criteria, multivariable competing risk analysis identified use of non-steroidal anti-inflammatory drugs or steroids and active malignancy as risk factors for MACCE. Diabetes and left ventricular ejection fraction <35 % were MACCE predictors and both were more prevalent among HBR patients. Dual antiplatelet therapy duration of ≥3 months significantly reduced risk of MACCE and was less prevalent among HBR.

CONCLUSIONS

The higher observed ischemic risk among HBR patients might not be explained by bleeding risk status itself but rather with some of its components and other underlying comorbidities and management strategies. These findings may be useful when evaluating the balance of ischemic and bleeding risks based on patient-specific risk factors.

2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

METHODS

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

STRUCTURE

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Anti-Inflammatory and Antioxidant Effects of White Grape Pomace Polyphenols on Isoproterenol-Induced Myocardial Infarction

Grape pomace (GP), the residue left after grape pressing in winemaking, is rich in polyphenols, including flavonoids, tannins, and phenolic acids, which have antioxidant and anti-inflammatory properties. The present study aimed to evaluate the cardioprotective effects of white grape pomace (WGP) extract in two concentrations rich in polyphenols (795 mg polyphenols from WGP/kg body weight (bw) and 397.5 mg polyphenols from WGP/kg bw)), on isoproterenol (ISO)-induced myocardial infarction (MI), focusing on its anti-inflammatory and antioxidant effects. White grape pomace administration for 14 days offered a cardio-protective effect and prevented prolongation of the QT and QTc intervals on the electrocardiogram. Both concentrations of WGP prevented the elevation of nitric oxide (NO) and malondialdehyde (MDA) in the serum, with the best results being observed for the highest concentration (p < 0.05). White grape pomace administration offered a reduction in pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and interleukin 1β (IL-1β) in both serum and tissue in a dose-dependent manner, with the highest WGP concentration having the best effect (p < 0.05). Moreover, WGP reduced histological changes associated with MI. The findings of the present study demonstrate that WGP extract exerts cardio protective effects by reducing MI-associated inflammation and oxidative stress.

Long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention without standard modifiable cardiovascular risk factors: findings from the OPT-CAD cohort

BACKGROUND

Acute coronary syndrome (ACS) patients without standard modifiable cardiovascular risk factors (SMuRFs) have a higher risk of early mortality. However, little is known about their long-term outcomes, especially for patients undergoing percutaneous coronary intervention (PCI). This study aims to explore the long-term outcomes and identify independent factors associated with adverse clinical outcomes in patients with ACS undergoing PCI without SMuRFs.

METHODS

This study used data from Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) registry study. Clinical characteristics and outcomes of patients with and without SMuRFs were examined. The primary outcomes were major adverse cardia-cerebrovascular events (MACCE). The long-term (5 years) outcomes were compared between the without and with SMuRFs group in such cohort. An exploratory Cox proportional hazards regression was performed to identify the independent demographic and clinical predictors of the adverse clinical outcomes in the SMuRFs-absent cohort.

RESULTS

Among 5688 patients with ACS undergoing PCI, 392 (6.9%) were in the absence of SMuRFs and 5296 (93.1%) were in the presence of SMuRFs. There were no significant differences in MACCE rates between the two cohorts (9.44% vs. 9.76%, log-rank P = 0.90). Cox proportional hazards regression indicated that age (HR, 1.06; 95% CI, 1.03-1.10; P = 0.001) and thrombus lesions (HR, 2.58; 95% CI, 1.24-5.40; P = 0.011) were independently associated with MACCE in the SMuRFs-absent cohort.

CONCLUSIONS

Among patients with ACS undergoing PCI, SMuRFs-absent patients had similar MACCE rates when compared with those with one or more SMuRFs at 5 years. This suggests that effective intervention strategies and updated risk assessment models are urgently needed in the SMuRFs-absent cohort.

Cancer and myocardial injury in patients with suspected acute coronary syndrome

BACKGROUND

Cancer and cardiovascular diseases are the leading causes of mortality worldwide, as they share common risk factors and exacerbate cardiovascular outcomes when they coexist. This study aimed to assess the clinical characteristics and cardiovascular outcomes of patients with a history of cancer and myocardial injury (MI) presenting with suspected acute coronary syndrome (ACS) in an emergency setting.

METHODS

This retrospective cohort study included 3,626 patients admitted to the emergency department with suspected ACS between 2012 and 2013. Patients were categorized on the basis of their cancer history and the presence of MI. Clinical variables and the associations between cancer history and MI with all-cause mortality were analyzed over a four-year follow-up period via univariate and multivariate Cox regression models.

RESULTS

Of the cohort, 10.6% (n = 384) had a history of cancer. Compared with other groups, cancer patients with MI were older, had more comorbidities, and presented a higher incidence of type 2 myocardial infarction (T2MI). At the four-year follow-up, all-cause mortality was significantly greater among cancer patients with MI (68.8%) than among cancer patients without MI (32.4%) and noncancer patients with or without MI (42.5% vs. 11.3%, respectively). Multivariate analysis identified cancer patients, particularly those with MI, as independent predictors of mortality.

CONCLUSIONS

Patients who present to emergency departments with suspected ACS, a history of cancer, or the presence of MI face greater cardiovascular risk and mortality than other patients do. The higher prevalence of T2MI in this population underscores the need for tailored management strategies.

Myocardial Work Analysis in ST-Elevation Myocardial Infarction: Insights into Left Ventricular Ejection Fraction-A Pilot Study

(1) Background: Left ventricular ejection fraction (LVEF) is traditionally used to assess prognosis in acute ST-elevation myocardial infarction (STEMI) patients. However, LV myocardial work (MW), evaluated echocardiographically, offers additional prognostic information by considering loading conditions. (2) Methods: This prospective study investigated the prognostic value of MW indices in 119 consecutive STEMI patients treated with primary percutaneous coronary angioplasty, stratified into three LVEF categories: reduced (≤40%), mildly reduced (41-49%), and preserved LVEF (≥50%). Transthoracic echocardiography was performed before discharge, and the primary endpoint included heart failure hospitalization, ventricular arrhythmias, all-cause mortality and new acute coronary syndromes. (3) Results: Patients with preserved or mildly reduced LVEF had higher global longitudinal strain, global work index, global constructive work (GCW), and global work efficiency, as well as lower global wasted work (GWW), compared to those with reduced LVEF. GCW was the strongest predictor of adverse outcomes in the preserved LVEF group (AUC = 0.730, p = 0.035), while GWW demonstrated robust predictive performance in the reduced LVEF group (AUC = 0.787, p = 0.001). (4) Conclusions: MW indices, particularly GCW and GWW, provide significant prognostic value in distinct LVEF categories in STEMI patients. These findings indicate that MW enhances risk stratification and informs management in this patient population.

Myocardial injury in spontaneous intracerebral hemorrhage is not predicted by prior cardiac disease or neurological status: results from the Mannheim Stroke database

Background and aims

Elevated cardiac troponin (cTn) levels (representing myocardial injury) are frequently found in patients with spontaneous intracerebral hemorrhage (sICH). Overall, the relationship between sICH and elevated cTn levels is not well understood. The aim of this study was to investigate patient characteristics and clinical parameters in patients with sICH and myocardial injury.

Methods

This is a retrospective observational study based on the Mannheim Stroke database. Consecutive patient cases with acute symptomatic sICH and available high-sensitivity cTn I (hs-cTnI) at hospital admission between 2015 and 2021 were included. Group comparisons of patient, clinical and imaging characteristics were performed between groups with and without hs-cTnI elevation. In addition, variables with suspected predictive clinical significance for hs-cTnI elevation were analyzed for their predictive value using multivariate logistic regression analysis.

Results

A total of 93/498 patients with sICH (18.7%; mean age 73 ± 15 years; 51.9% females) had a hs-cTnI elevation. These patients did not have a more pronounced cerebrovascular risk profile and had a comparably low prevalence of coronary artery disease (18.5%, p = NS) compared to those without elevated hs-cTnI levels. Elevated hs-cTnI levels had no impact on in-hospital mortality (21.5 vs. 20.5%, p = NS) or functional outcome at discharge. Solely clinically relevant aortic valve stenosis, graded as moderate or higher, independently predicted hs-cTnI elevation (p < 0.003). Other cardiac preconditions or neurological functional parameters did not serve as significant predictors.

Conclusions

Myocardial injury is common in patients with sICH. Unlike in AIS patients, elevated hs-cTnI levels were not associated with a worse functional or mortality-related in-hospital outcome. Except for clinically relevant aortic valve stenosis, structural heart disease had no significant influence as a predictor. We therefore suggest that hs-cTnI elevation in patients with sICH is related to acute myocardial damage along the brain-heart axis.

Biomarkers of inflammation in sweat after myocardial infarction

ST-elevation myocardial infarction (STEMI) triggers a significant inflammatory response. Sweat may offer a novel, non-invasive medium for monitoring inflammation. In this prospective study, we characterized the inflammatory signatures in plasma and sweat collected from the skin surface of two patient groups: (1) 18 STEMI patients immediately following percutaneous coronary intervention (exposure) and (2) six patients who underwent outpatient angiography without subsequent intervention (control). Levels of 92 biomarkers were measured using a high-throughput proteomic assay and reassessed after 4-6 weeks in STEMI patients. Adjusting for patient group, sweat biomarkers did not show significant changes over time. In plasma, hepatocyte growth factor and interleukin-6 showed a significant decrease from the acute phase to follow-up, adjusted for patient group. STAM binding protein was significantly higher in the sweat of STEMI patients compared to controls, adjusted for time effects. While sweat was less sensitive than plasma for detecting biomarker levels in the setting of STEMI, its longitudinal analysis via wearable sensors holds promise for detecting specific markers.Trial registration: The trial is registered on www.clinicaltrials.gov with the trial registration number NCT05843006.

Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial

BACKGROUND

Clinical trials and meta-analyses indicate a reduced reinfarction risk with invasive management in older patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study investigated whether similar benefits might be observed in frail patients.

METHODS

The coMOrbilidades Síndrome Coronario Agudo - FRAIL (MOSCA-FRAIL) trial included 167 adults aged ≥70 years with frailty (Clinical Frailty Scale ≥4 points) and NSTEMI, who were randomised to invasive (n=84) or conservative (n=83) strategy during the index hospitalisation. The primary end point of this subanalysis was reinfarction, considering all-cause mortality as a competing event, at a 3-year median follow-up. The time to first reinfarction and all reinfarctions (first and recurrent) were considered. The substudy was not prespecified.

RESULTS

The total number of deaths (93, 56%) exceeded that of first reinfarctions (32, 19%). Invasive treatment did not influence the reinfarction risk when accounting for death as a competing risk (subdistribution HR=0.87, 95% CI 0.54 to 1.40, p=0.56). An initially increased mortality risk with invasive management (significant between days 131 and 175) shifted to a lower mortality risk over time. A total of 45 reinfarctions (first and recurrent) were observed. The longitudinal trajectories corroborated that the invasive strategy did not reduce the risk of reinfarction over time (p=0.72). However, mortality followed a biphasic pattern, with higher mortality in the invasive group during the first 6 months and a reduction between 9 months and 3 years (p=0.05 for the entire time-dependent trajectory). The win ratio for the invasive strategy versus the conservative strategy was 1.08 (95% CI 0.72 to 1.63, p=0.70).

CONCLUSIONS

In older adults with frailty and NSTEMI, routine invasive management did not reduce the reinfarction risk at a 3-year follow-up. The high all-cause mortality associated with frailty may limit the impact of invasive management. Due to the limited sample size and risk for type II error, these findings should be considered hypothesis-generating.

TRIAL REGISTRATION NUMBER

NCT03208153.

Percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease: the SWEDEHEART registry

BACKGROUND AND AIMS

The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated.

METHODS

The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality; the secondary endpoints included myocardial infarction (MI), stroke, new revascularization, and heart failure. Multilevel logistic regression with follow-up time as a log-transformed offset variable and double-robust adjustment with the instrumental variable method were applied to control for known and unknown confounders.

RESULTS

Percutaneous coronary intervention was the primary therapy in 42 190 (73.9%) patients, while 14 907 (26.1%) received CABG. Percutaneous coronary intervention patients were generally older with more prior cardiovascular events, whereas CABG patients had higher incidences of diabetes, hypertension, left main and three-vessel disease, and reduced ejection fraction. Over a median follow-up of 7.1 years, PCI was associated with higher risks of death [adjusted odds ratio (aOR) 1.67; 95% confidence interval (CI) 1.54-1.81] and MI (aOR 1.51; 95% CI 1.41-1.62) but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95% CI 2.57-3.51), while heart failure risk was 15% higher (aOR 1.15; 95% CI 1.07-1.25). Coronary artery bypass grafting provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though this benefit diminished over shorter time horizons.

CONCLUSIONS

Coronary artery bypass grafting is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.

Type 2 myocardial infarction: challenges in diagnosis and treatment

The Fourth Universal Definition of Myocardial Infarction recommends a classification based on aetiology, in recognition that the underlying pathophysiology of myocardial infarction influences the approach to investigation and treatment. Type 1 myocardial infarction occurs due to atherosclerotic plaque rupture with thrombosis, whereas type 2 myocardial infarction occurs due to an imbalance in myocardial oxygen supply or unmet need in myocardial oxygen demand, without atherothrombosis, usually in the context of another acute illness. In this state-of-the-art review, the diagnosis, investigation, and treatment of patients with type 2 myocardial infarction are considered, with general advice for clinical practice and a consideration of future research directions.

Cardiac Biomarkers Predict Major Adverse Cardiac Events (MACE) in Incident Haemodialysis Patients: Results from a Global Federated Database

Background: Despite its many advantages, haemodialysis (HD) has been shown to be associated with significant cardiovascular events, especially in patients commencing HD. Currently, there is no specific method to risk-stratify incident HD patients. Blood-based biomarkers provide insight into myocardial injury and stress. We aimed to evaluate the association of increased circulating biomarker concentration in incident HD with incident major adverse cardiac events (MACE). Methods: This was a retrospective cohort study of incident haemodialysis cases within 3 months of treatment initiation (≥18 years) from the TriNetX database. Cohorts were grouped by biomarker thresholds: Troponin I: ≥50 ng/L, BNP ≥ 100 pg/mL and 1:1 propensity-score matched for demographic characteristics, baseline cardiovascular risk, laboratory values, and cardiovascular medication. Primary outcome: Incidence of major adverse cardiac events (MACE) censored prior to index event of HD. Secondary outcome: Risk of each individual component of the composite outcome. Cox regression reported hazard ratios (95% CI) for the outcomes. Results: In total, 62,206 and 10,476 patients were included in the troponin I and BNP cohorts, respectively. In the troponin I cohort, 5878 developed MACE (HR 1.33 (95% CI 1.26-1.41, p < 0.0001)). In the BNP cohort, 1050 developed MACE (HR 1.28 (95% CI 1.13-1.44, p < 0.0001)). Conclusions: In incident HD, routine clinical laboratory biomarkers can predict incident MACE. The results suggest the clinical need for CV mortality and morbidity risk profiling in incident HD using a combination of clinical and laboratory variables.

Which Parameter Related to Low-Density Lipoprotein Cholesterol is Superior for Predicting the Recurrence of Myocardial Infarction in Young Patients with Previous Coronary Heart Disease? A Real-World Study

Background

Lowering low-density lipoprotein cholesterol (LDL-C) is a well-established strategy for the secondary prevention of coronary heart disease (CHD). However, the effectiveness of specific LDL-C parameters in predicting myocardial infarction (MI) recurrence in real-world settings remains inadequately explored. This study aims to examine the relationship between MI recurrence and various LDL-C parameters in young CHD patients.

Methods

This retrospective cohort study involved 1013 patients aged 18-44 at the time of initial CHD diagnosis, collected from the cardiology department clinics at Beijing Anzhen Hospital between October 2022 and October 2023. LDL-C levels were assessed at the time of CHD diagnosis and at the final follow-up. The primary outcome was MI events, analyzed using survival analysis and logistic regression models to determine associations with LDL-C parameters.

Results

The study included 1013 patients (mean age: 38.5 ± 3.9 years; 94.7% men), with a median follow-up time of 1.7 years. Initially, 13.6% had LDL-C levels <1.8 mmol/L, which increased to 37.8% by the study's end. During follow-up, 96 patients (9.5%) experienced MI. While LDL-C <1.8 mmol/L at baseline showed a slightly lower cumulative incidence of MI than LDL-C ≥1.8 mmol/L, the difference was not statistically significant (log-rank p = 0.335). Reductions in LDL-C levels of ≥50% and the patterns of change did not correlate with decreased MI risk. However, LDL-C <1.4 mmol/L at the final measurement was associated with a reduced MI risk (adjusted odds ratio [OR]: 0.57, 95% confidence interval [CI]: 0.33-0.98) compared with LDL-C ≥2.6 mmol/L.

Conclusions

This study suggests that the most important parameter related to LDL-C for predicting the recurrence of MI in young patients with a history of CHD is the ideal target LDL-C level. Lowering LDL-C to <1.4 mmol/L could potentially reduce MI risk, regardless of baseline LDL-C levels.

Application of Machine Learning Algorithms in Predicting Major Adverse Cardiovascular Events after Percutaneous Coronary Intervention in Patients with New-Onset ST-Segment Elevation Myocardial Infarction

Background

This study aimed to develop and validate a predictive model for major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI) in patients with new-onset ST-segment elevation myocardial infarction (STEMI) using four machine learning (ML) algorithms.

Methods

Data from 250 new-onset STEMI patients were retrospectively collected. Feature selection was performed using the Boruta algorithm. Four ML algorithms-K-nearest neighbors (KNN), support vector machine (SVM), Complement Naive Bayes (CNB), and logistic regression-were applied to predict MACE risk. Model performance was evaluated using area under the curve (AUC), sensitivity, and specificity. Shapley Additive Explanations (SHAP) analysis was used to rank feature importance, and a nomogram was constructed for risk visualization.

Results

Logistic regression showed the best performance (AUC = 0.814 in training, 0.776 in validation) compared to KNN, SVM, and CNB. SHAP analysis identified seven key predictors, including Killip classification, Gensini score, blood urea nitrogen (BUN), heart rate (HR), creatinine (CR), glutamine transferase (GLT), and platelet count (PCT). The nomogram provided accurate risk predictions with strong agreement between predicted and observed outcomes.

Conclusions

The logistic regression model effectively predicts MACE risk after PCI in STEMI patients. The nomogram serves as a practical tool for clinicians, supporting personalized risk assessment and improving clinical decision-making.

Impact of papillary muscle infarction on atrial and ventricular myocardial deformation in non-anterior STEMI patients

The purpose of this study was to explore the impact of papillary muscle (PPM) infarction on left atrial and ventricular strain parameters in patients with non-anterior ST-segment elevation myocardial infarction (NA-STEMI) using cardiovascular magnetic resonance (CMR). This retrospective study performed CMR scans on 88 consecutive patients with NA-STEMI (68 males, 65 ± 10.05 years). Among them, 30 demonstrated PPM infarction (25 males, 67.12 ± 9.49 years), defined as late gadolinium enhancement (LGE) in a papillary muscle head in two contiguous LGE CMR slices, and confirmed on the long-axis LGE CMR slices. Atrial and ventricular strain were analyzed by CMR feature tracking with dedicated post-processing software. Patients with PPM infarction were older (p = 0.001), with lower left ventricular ejection fraction (p = 0.040), higher indexed left ventricular end-diastolic volume (p = 0.020), and end-systolic volume (p = 0.044) compared to patients without LGE in the papillary muscle. Additionally, patients with PPM infarction showed impaired reservoir strain, booster strain, global longitudinal strain (GLS), and higher LGE extent compared to NA-STEMI patients without PPM involvement (p = 0.001, p = 0.004, p = 0.001, and p = 0.003, respectively). In multivariable analysis, GLS, global radial strain, reservoir strain, and booster strain parameters were the only independent determinants of PPM infarction (p = 0.001, p = 0.041, p = 0.002, and p = 0.027, respectively). The presence of PPM infarction assessed by CMR is independently linked to atrial and ventricular strain impairment in patients with NA-STEMI.

Diagnostic Performance of Quantitative Flow Ratio for the Assessment of Non-Culprit Lesions in Myocardial Infarction (QFR-OUTSMART): Systematic Review and Meta-Analysis

BACKGROUND

Quantitative flow ratio (QFR) analysis is a simple and non-invasive coronary physiological assessment method with evidence for evaluating stable coronary artery disease with correlation to fractional flow reserve (FFR). However, there is no evidence to recommend its use in non-culprit lesions (NCLs) in myocardial infarction (MI).

METHODS

We performed a systematic review and meta-analysis using the PRISMA and PROSPERO statements. The study's primary objective was to assess the diagnostic accuracy of QFR in identifying functionally significant NCLs after MI based on invasive FFR and non-hyperemic pressure ratios as references. We obtained values of the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We performed a leave-one-out sensitivity analysis for each study's impact on the overall effect.

RESULTS

We included eight studies, with 713 patients and 920 vessels evaluated with QFR. The overall AUC was 0.941 (I2 = 0.559, p < 0.002), with a sensitivity of 87.3%, a specificity of 89.4%, a PPV of 86.6%, and an NPV of 90.1%. Compared to FFR, we found an AUC of 0.957 (I2 = 0.331, p < 0.194), a sensitivity of 89.6%, a specificity of 89.8%, a PPV of 88.3%, and an NPV of 91%. The sensitivity analysis showed a similar diagnostic performance in both studies.

CONCLUSIONS

QFR is effective in analyzing NCLs with a significant diagnostic yield compared to FFR, with an excellent AUC in MI patients. Performing prospective multicenter studies to characterize this population and reproduce our results is essential.

Molecular insight of miRNA-217 role in the pathogenesis of myocardial infarction: Promising diagnostic biomarker and therapeutic target

Background

Globally, myocardial infarction (MI) is one of the main causes of death. This study aims to investigate the role of miR-217 in the pathogenesis through targeting MAPK and PI3K/AKT signaling pathways in experimental model of myocardial infarction and studying the possible cardioprotective role of dihydromyricetin (DHM) through modulation of this pathway.

Methods

Dihydromyricetin was injected (100 mg/kg; p.o.) in isoprenaline induced myocardial infarction rat model for 14 days. Rats were anaesthetized and blood samples were taken for serum separation, estimation of creatine kinase-MB (CK-MB), and troponin-I levels after 24 h had passed since the last isoprenaline injection. In addition, the hearts were also used for the other biochemical studies and the histological evaluation.

Results

DHM resulted in a significant suppression of the elevated levels miR-217 and MAPK compared to the MI control group and restored the normal level of serum CK-MB. Furthermore, DHM successfully restored the oxidative balance and halted the pro-inflammatory mediators in the cardiac tissue.

Conclusion

Accordingly, our experiment emphasizes the anti-ischemic property that has been demonstrated through modulation of expression level of miR-217 and consequent deactivation of MAPK and PI3K/AKT signaling pathways, and this was assured by halting downstream pro-inflammatory markers.

Regulated cell death in acute myocardial infarction: Molecular mechanisms and therapeutic implications

Acute myocardial infarction (AMI), primarily caused by coronary atherosclerosis, initiates a series of events that culminate in the obstruction of coronary arteries, resulting in severe myocardial ischemia and hypoxia. The subsequent myocardial ischemia/reperfusion (I/R) injury further aggravates cardiac damage, leading to a decline in heart function and the risk of life-threatening complications. The complex interplay of multiple regulated cell death (RCD) pathways plays a pivotal role in the pathogenesis of AMI. Each RCD pathway is orchestrated by a symphony of molecular regulatory mechanisms, highlighting the dynamic changes and critical roles of key effector molecules. Strategic disruption or inhibition of these molecular targets offers a tantalizing prospect for mitigating or even averting the onset of RCD, thereby limiting the extensive loss of cardiomyocytes and the progression of detrimental myocardial fibrosis. This review systematically summarizes the mechanisms underlying various forms of RCD, provides an in-depth exploration of the pathogenesis of AMI through the lens of RCD, and highlights a range of promising therapeutic targets that hold the potential to revolutionize the management of AMI.

Diagnostic accuracy of point-of-care cardiac ultrasound for acute coronary syndromes in patients presenting with chest pain to the emergency department: a single-center prospective study

BACKGROUND AND IMPORTANCE

The diagnostic accuracy of focused cardiac ultrasound (FoCUS) performed in patients presenting to the emergency department (ED) with chest pain is currently unknown.

OBJECTIVE

The objective of this study was to assess the diagnostic accuracy of regional wall motion abnormalities detected with FoCUS for non-ST-elevation acute coronary syndrome (NSTE-ACS) diagnosis.

DESIGN

A Single-center prospective observational study conducted in 2022 in the ED of the University Hospital Careggi, Italy.

SETTING AND PARTICIPANTS

Adult patients presenting to the ED with acute nontraumatic chest pain were enrolled, irrespective of the presence of previous regional wall motion abnormalities. Patients with ST-segment elevation myocardial infarctions and patients with hemodynamic instability were excluded. FoCUS was performed at presentation by a trained ED physician.

OUTCOME MEASURES AND ANALYSIS

The final diagnosis of NSTE-ACS vs. alternative diagnosis was adjudicated by an ED physician blinded to FoCUS results after a 30-day follow-up. To assess if regional wall motion abnormalities were an independent predictor of NSTE-ACS, a multivariable logistic regression model was built. Diagnostic performance measures were calculated. A sensitivity analysis considering only type-1 NSTEMIs (i.e. plaque rupture/thrombosis) was conducted.

MAIN RESULTS

Among 686 patients, NSTE-ACS was adjudicated in 106 (15.5%) patients, 67 of which were NSTEMIs. A total of 87 (12.7%) patients had regional wall motion abnormalities detected by FoCUS, which were an independent predictor of NSTE-ACS in the multivariable logistic regression analysis. Regional wall motion abnormalities had a sensitivity of 42.5% (33.0-51.9), a specificity of 92.8% (90.6-94.9), a negative predictive value of 89.8% (87.4-92.2), and a positive predictive value of 51.7% (41.2-62.2), for NSTE-ACS. Results were consistent in the sensitivity analysis.

CONCLUSIONS

In ED patients with chest pain and no ST elevation, the detection of regional wall motion abnormalities was a predictor of NSTE-ACS. Despite a high specificity, which indicated a possible role of FoCUS in the rule-in of NSTE-ACS, sensitivity was too low to allow a safe rule-out using FoCUS results alone.

[Management of acute coronary syndrome]

Coronary artery disease (CAD) is the leading cause of death worldwide. Acute coronary syndrome (ACS) encompasses a spectrum of diagnoses ranging from unstable angina pectoris to myocardial infarction with and without ST-segment elevation and frequently presents as the first clinical manifestation. It is crucial in this scenario to perform a timely and comprehensive assessment of patients by evaluating the clinical presentation, electrocardiogram and laboratory diagnostics using highly sensitivity cardiac troponin in order to initiate a timely and risk-adapted continuing treatment with immediate or early invasive coronary angiography. In addition to revascularization, the subsequent antithrombotic and lipid-lowering treatment plays a major role in the further secondary prevention of CAD. The choice and duration of medication over time should be tailored to the individual risk profile of the patient. Furthermore, appropriate patient education regarding risk factor management is of paramount importance.

Customizable patterned membranes for cardiac tissue engineering: A model-assisted design method

Myocardial infarction can cause irreversible damage to the heart muscle, which can lead to heart failure. The difficulty of the treatment mainly arises from the anisotropic behavior of the myocardium fibrous structure. Patches or cardiac restraint devices appear to be a promising approach to post-infarction treatment. In this study, we propose a new model-assisted method to design patterned membranes. The proposed approach combines computer experiments and statistical models to optimize the design parameters and to meet the requirement for the post-infarction treatment. Finite element model, global sensitivity analysis, random forest model and response surface model are the key components of the strategy implemented in this study, which is applied to design a real membrane. The metamodel-based design method is able to estimate the equivalent Young's modulus of the membrane in a few seconds and optimization results have been validated a posteriori by laboratory measurements. This solution opens up new prospects for the design of customized membranes with technical specifications tailored to each patient.

Septic cardiomyopathy or myocardial infarction?: A case report of septic shock with ST-segment elevation on ECG

RATIONALE

Sepsis is one of the most prevalent and deadly diseases today. Sepsis involving the heart can progress to septic cardiomyopathy; however, there is a lack of uniform diagnostic criteria. A review of the literature reveals a paucity of literature on sepsis combined with acute myocardial infarction (AMI) and no reports on emergency surgical treatment.

PATIENTS CONCERNS

A 52-year-old patient with trauma-induced sepsis leading to acute heart failure with elevated ST-segment on electrocardiogram and postoperative coronary angiography suggestive of AMI.

DIAGNOSES

Small bowel rupture, infectious shock, AMI, hypertensive disease, old cerebral infarction.

INTERVENTIONS

The patient was admitted to the hospital and immediately underwent emergency surgery to remove the infected focus, with treatment with meropenem for anti-infection, ambroxol for sputum, parenteral nutritional support, sedation and analgesia, esmolol to control the ventricular rate, uradil to control blood pressure, and transfusion of red blood cells and plasma for correction of anemia and coagulation functions. Coronary angiography was performed 6 months later.

OUTCOMES

The patient was discharged after showing signs of improvement and was subsequently monitored in an outpatient clinic setting. At the time of writing, the patient is still alive and well.

LESSONS

In cases of acute heart failure resulting from trauma-induced sepsis, it is crucial to consider myocardial ischemia as a potential factor. Early surgical removal of infected foci may prove beneficial in improving the patient's prognosis. However, differentiating between septic cardiomyopathy and sepsis-combined myocardial infarction can be challenging, and the appropriateness of the diagnostic criteria for sepsis at this stage is debatable.

Hepatic T1 mapping as a novel cardio-hepatic axis imaging biomarker early after ST-elevation myocardial infarction

AIMS

The hepatic response after ST-elevation myocardial infarction (STEMI) may be associated with mortality and morbidity. We aimed to assess the cardio-hepatic axis post-STEMI using cardiovascular magnetic resonance (CMR).

METHODS AND RESULTS

This prospective, observational, single-centre study included consecutive patients with STEMI who underwent CMR after primary angioplasty from January 2015 to January 2019. Standard infarct characteristics were analysed, and hepatic T1 and hepatic extracellular volume (ECV) were assessed using pre- and post-contrast T1 mapping sequences. The primary endpoint was the relationship between native hepatic T1 values and ischaemic right ventricular (RV) involvement, determined by RV ejection fraction (EF) dysfunction and/or the presence of RV acute myocardial infarction (AMI). The diagnostic performance of hepatic T1 values for detecting RV involvement was assessed using the area under the receiver operating characteristic curve (AUC). Of 177 consecutive patients with STEMI undergoing CMR, 142 were included. Patients with RV ischaemic involvement, compared with those without, had significantly higher native hepatic T1 (P < 0.001) and hepatic ECV (P = 0.016). Hepatic T1 values demonstrated a good diagnostic performance in detecting RV involvement (AUC 0.826, P < 0.001) and correlated positively with NT-proBNP values (r = 0.754, P < 0.001). Patients with high hepatic T1 values (> 605 ms) had significantly higher NT-proBNP levels (< 0.001), larger RV end-diastolic volume (P < 0.001), lower RVEF (P < 0.001), and a higher prevalence of RV AMI (P = 0.022) compared with those with hepatic T1 ≤ 605 ms, whereas left ventricular EF and infarct size were similar. Multivariable logistic regression analysis identified RVEF (P = 0.010) and NT-proBNP values (P < 0.001) as independent predictors of increased hepatic T1 values. Patients with increased hepatic T1 values had a higher rate of rehospitalization for heart failure at 17-month follow-up (12.1 vs. 2.0%, P = 0.046).

CONCLUSION

Hepatic T1 mapping has emerged as a possible novel imaging biomarker of the cardio-hepatic axis in STEMI, being associated with RV involvement and increased NT-proBNP values.

Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes

The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.

Impact of impaired renal function on kinetics of high-sensitive cardiac troponin following cardiac surgery

BACKGROUND

Impaired renal function can increase cardiac troponin levels due to reduced elimination, potentially affecting its diagnostic utility. Limited data exist on high-sensitivity cardiac troponin I (hs-cTnI) kinetics after cardiac surgery relative to renal function. This study evaluates how impaired renal function influences hs-cTnI kinetics following cardiac surgery, distinguishing between patients with and without postoperative myocardial infarction (PMI).

METHODS

We conducted a retrospective analysis of adult patients who underwent elective cardiac surgery at our hospital from January 2013 to May 2019. Serial hs-cTnI measurements were taken from baseline up to 48 h post-surgery. Renal function was assessed using the MDRD formula, defining impaired renal function as a GFR < 60 ml/min. Acute kidney injury (AKI) was based on postoperative creatinine levels, and PMI was defined by ARC-2 criteria. Predictors of long-term all-cause mortality were analyzed using Cox regression.

RESULTS

Out of 14,355 patients (51.4% CABG, 39.4% valvular procedures, 9.2% thoracic aortic procedures), 139 (1.0%) had PMI. Hs-cTnI levels were higher in patients with impaired renal function across the cohort and in those without PMI. However, in patients with PMI, hs-cTnI levels did not vary significantly with renal function. Elevated hs-cTnI ≥ 213 times the upper limit of normal was a significant predictor of long-term mortality regardless of renal function (hazard ratio: 1.28, 95% CI: 1.17-1.40, p < 0.001), but early postoperative hs-cTnI measures held poor discriminatory yield to predict PMI with an AUC of 0.55 (95% confidence intervals: 0.54-0.56).

CONCLUSION

Renal function and acute kidney injury affect hs-cTnI kinetics post-surgery only in patients without PMI. Elevated hs-cTnI remains a strong predictor of long-term mortality, independent of renal function, but early postoperative detection of PMI requires additional metrics, including ECG, transthoracic echocardiography (TTE), and signs of hemodynamic instability.

Evaluation of LVEDP Change During High-Risk PCI With and Without Impella Support (ELVIS)-A Pilot Trial

Background: The decision-making process to use percutaneous mechanical circulatory support in the context of elective high-risk percutaneous coronary intervention (HRPCI) is complex and evolving. The aim of this study is to evaluate the left ventricular end-diastolic pressure (LVEDP) as a parameter to identify patients that may benefit from a protected HRCPI (pHRPCI) procedure. Methods: Overall, 62 patients (pHRPCI n = 31 vs. non-pHRPCI n = 31) with a complex coronary artery disease and a left ventricular ejection fraction (LVEF) ≤35% were included. The primary endpoint was defined as a change in LVEDP and its correlation with laboratory measurements. The secondary safety endpoint was a composite of the incidence of major in-hospital adverse cardiac and cerebrovascular events (MACCE). Results: Baseline characteristics were similar, including age (pHRPCI 72.8 ± 8.8 vs. non-pHRPCI 75.0 ± 10.4; p = 0.408), male (pHRPCI 83.9% vs. non-pHRPCI 96.8; p = 0.195), pre-PCI Syntax Score (pHRPCI 33.9 ± 13.1 vs. non-pHRPCI 35.4 ± 12; p = 0.643), post-PCI Syntax Score (pHRPCI 7.4 ± 6.2 vs. non-pHRPCI 9.6 ± 8.4; p = 0.239) and baseline LVEDP between the groups (pHRPCI 18.5 ± 10.5 mmHg vs. non-pHRPCI 15.7 ± 8.1 mmHg; p = 0.237). There was a trend to a lower LVEF in the pHRPCI group (26.4 ± 6.7% vs. 29.4 ± 5%; p = 0.051). The primary endpoint analysis revealed a significant change in LVEDP (pHRPCI -4.7 ± 9 mmHg vs. non-pHRPCI +3.1 ± 7.5 mmHg; p < 0.001) that did not correlate with changes in creatinine (p = 0.285), NT-proBNP (p = 0.383) or troponin (p = 0.639) concentrations within 24 h. Overall, low rates of in-hospital (pHRPCI 6.5% vs. non-pHRPCI 3.2%; p = 0.999) and 90-days (pHRPCI 12.9% vs. non-pHRPCI 12.9%; p = 0.999) MACCE were observed in both groups. Conclusions: Protected HRPCI leads to a significant reduction in LVEDP without influencing biomarkers of myocardial damage. There was no difference in MACCE rates between the groups.

Acceptance of Illness and Health-Related Quality of Life in Patients After Myocardial Infarction-Narrative Review

Introduction: Cardiovascular diseases, particularly myocardial infarction (MI), significantly impact patients' lives, causing stress and prompting varied responses to illness. Aim and methods: We conducted a narrative review concerning the acceptance of illness and quality of life in post-MI patients. Based on an extensive search of the available literature, this review consolidates current evidence on the proposed topic. Conclusions and implications: While some patients struggle with acceptance and face emotional distress, others who accept their condition are more likely to engage in treatment and lifestyle changes, leading to an improved health-related quality of life (HRQoL). Following an MI, patients often experience depression, anxiety, and stress, complicating their acceptance of the illness. Risk factors, such as hypertension, diabetes, and smoking, play a significant role in influencing HRQoL in post-MI patients. An accurate assessment of HRQoL is crucial for tailoring effective treatments and support strategies to enhance patient outcomes and identify those most at risk of developing post-MI depression or anxiety. Effective physician-patient and nurse-patient communication and support from family might be helpful in recovery. Cardiac rehabilitation improves patients' outcomes and HRQoL. This review underscores the importance of integrating psychological support with optimal medical care to improve patient prognosis and enhance the HRQoL of individuals recovering from MI. The healthcare system could implement routine psychological assessments for MI patients at admission and discharge to establish a baseline for follow-up. Future research should explore effective psychological interventions, the interplay of CVD risk factors and psychosocial aspects, the emerging role of artificial intelligence in personalized care, and the cost-effectiveness of integrated treatment models.

Increased Plasma Pyruvate Kinase M2 (PK-M2) in Heart Failure: A Novel Biomarker Related to Cardiac Function and its Clinical Implications

BACKGROUND

The purpose of this study was to investigate whether circulating pyruvate kinase M2 (PK-M2) levels are elevated in the peripheral blood and to assess their association with diagnosis and prognosis in patients with heart failure (HF).

METHODS AND RESULTS

We conducted a prospective investigation involving 222 patients with HF and 103 control subjects, measuring PK-M2 concentrations using ELISA. The primary outcome, assessed over a median follow-up of 2 years (interquartile range: 776 to 926 days), was the time to the first occurrence of either rehospitalization for worsening HF or cardiovascular death. Patients with HF had higher PK-M2 levels than controls (17.4±4.1 versus 7.8±2.3 U/mL, P <0.001), and these levels correlated with HF severity (New York Heart Association cardiac function class). Patients with reduced left ventricular ejection fraction had higher PK-M2 concentrations than those with preserved ejection fraction (18.3±4.5 versus 16.7±3.6 U/mL, P <0.01). In a subset of patients with HF (n=52), PK-M2 levels significantly decreased following standardized HF treatment (mean difference, -4.3±0.5 U/mL, P <0.001). A high PK-M2 level had a 1.913-fold higher risk of the primary outcome (P=0.033) after adjusting for multiple cardiovascular risk factors, but not with cardiovascular death. Additionally, PK-M2 added incremental prognostic value beyond clinical predictors and N-terminal pro-brain natriuretic peptide (P <0.05).

CONCLUSIONS

Elevated PK-M2 levels are associated with primary outcomes and rehospitalization for worsening heart failure in patients with HF. These findings suggest that PK-M2 is a potential biomarker for HF diagnosis and prognosis, warranting consideration for serial patient assessment.

Predictors and Impact of Cardiogenic Shock in Oldest-Old ST-Elevation Myocardial Infarction Patients

Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29-3.92, p < 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32-8.21, p < 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03-1.11, p < 0.001), PAD (HR: 1.29, 95% CI: 1.01-1.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32-3.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29-1.96, p < 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p < 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge.

Prognostication in emergency room patients: comparing ultrasensitive and contemporary quantification of cardiac troponin levels below the 99th percentile

Introduction

Cardiac troponin levels below the 99th percentile improve the predictive efficacy for cardiovascular events when associated with relevant clinical variables. However, whether ultra-sensitive analytical methods improve this predictive efficacy over less sensitive or contemporary analytical methods remains unknown.

Methods

This retrospective observational study involved consecutive patients who presented to the emergency department for suspected acute coronary syndrome and underwent measurement of ultra-sensitive cardiac troponin I (Singulex) and contemporary cardiac troponin I (Siemens) with levels below the 99th percentile. The clinical characteristics of these patients were analysed, and the efficacy of both analytical methods for predicting cardiovascular events over a 4-year follow-up period was compared.

Results

In total, 838 patients were analysed (mean age, 62.9 ± 16.6 years; 42.2% women). Their cumulative incidence of the composite cardiovascular event (death, readmission for myocardial infarction, and readmission for heart failure) was 25.9% over the 4-year follow-up. Both Singulex cardiac troponin I (analysed by quartiles) and Siemens cardiac troponin (analysed as detectable/undetectable) improved the predictive efficacy for the combined event over clinical variables [Harrell's C-index (95% confidence interval): 0.77 (0.74-0.80) vs. 0.79 (0.76-0.81) and 0.77 (0.74-0.80) vs. 0.78 (0.75-0.81), respectively; p = 0.018]. However, there were no statistically significant difference between the two predictive models that included the aforementioned troponin assays.

Conclusions

Detectable levels of cardiac troponin using a contemporary analytical method or those near the 99th percentile using an ultra-sensitive analytical method improve the predictive efficacy for cardiovascular events, with no differences between the two methods.

Six-year change in high-sensitivity cardiac troponin T with subsequent stroke risk in the general population

BACKGROUND

The association between change in high-sensitivity cardiac troponin T (hs-cTnT) and stroke risk in the general population remains unknown. We aimed to assess the association of a 6-year change in hs-cTnT with incident stroke and its subtypes in the general American adult population.

METHODS

8675 middle-aged adults without prevalent cardiovascular disease from the Atherosclerosis Risk in Communities study were included. Hs-cTnT was measured at two time points (visits 2 and 4), 6 years apart. The relative percentage change of hs-cTnT was defined as hs-cTnT at visit 4 minus that at visit 2, divided by hs-cTnT at visit 2. The study outcome was incident stroke and its subtypes. All data were analysed in 2023.

RESULTS

Over a median follow-up of 20.1 years, 682 incident strokes occurred, including 593 ischaemic and 89 haemorrhagic strokes. For absolute change, using low/low group as reference category, the low/high (adjusted HR 1.44, 95% CI 1.03 to 2.02) and high/high (adjusted HR 1.47, 95% CI 0.93 to 2.34) groups were associated with higher risk of stroke. Moreover, the relative percentage change in hs-cTnT with stroke followed an inverted L-shaped association, levelling off at about 75% increase in hs-cTnT (P for nonlinearity=0.009). Compared with those with ≤50% change in hs-cTnT, participants with >50% increase in hs-cTnT had a higher risk of stroke (adjusted HR 1.30, 95% CI 1.03 to 1.64). Similar results were found for ischaemic stroke. No significant association was found for haemorrhagic stroke.

CONCLUSION

Temporal increase in hs-cTnT was associated with a higher risk of incident total and ischaemic stroke in the general population.

Association between left ventricular reverse remodelling and the B-type natriuretic peptide-cGMP cascade after anterior acute myocardial infarction

BACKGROUND

The role of cyclic guanosine 3',5'-monophosphate (cGMP) after acute myocardial infarction (AMI) is not well understood despite its significance as a second messenger of natriuretic peptides (NPs) in cardiovascular disease. We investigated the association between the NP-cGMP cascade and left ventricular reverse remodelling (LVRR) in anterior AMI.

METHODS

67 patients with their first anterior AMI (median age, 64 years; male, 76%) underwent prospective evaluation of plasma concentrations of the molecular forms of A-type and B-type natriuretic peptide (BNP) and cGMP from immediately after primary percutaneous coronary intervention (PPCI) to 10 months post-AMI. The estimated mature BNP (emBNP) concentration was calculated as the difference between total BNP and prohormone of BNP (proBNP) concentrations. Patients were divided into LVRR and non-LVRR groups on the basis of residuals between observed change in left ventricular end-systolic volume index on MR during the first 11 months after AMI and change adjusted for proBNP concentration immediately post-PPCI, which was calculated with regression. The LVRR group (n=33) had residuals below the median; the non-LVRR group (n=34) had residuals at or above the median.

RESULTS

The LVRR group had higher freedom from major adverse cardiac and cerebrovascular events (MACCEs) than the non-LVRR group during a median follow-up of 9.9 years (p=0.008). The presence of LVRR (HR 0.256; 95% CI 0.081 to 0.809; p=0.028) and peak creatine phosphokinase-myocardial band level (per 100 IU/L) (HR 1.22; 95% CI 1.02 to 1.46; p=0.027) were independent predictors of MACCE after adjusting for age, male sex, infarct size and hypertension. Multivariable analyses identified logarithmic proBNP and emBNP concentrations from 12 hours to 5 days post-AMI and logarithmic cGMP concentration from immediately post-PPCI to 3 days post-AMI as independent predictors of LVRR (p<0.05).

CONCLUSIONS

Early-phase BNP-cGMP cascade activation might play a crucial role in LVRR in anterior AMI.

Correlation between Left Ventricular Mass and Cardiac Troponin T in Cardiac Surgery

Cardiac troponin levels might rise significantly after cardiac surgeries as a surgical outcome rather than ischemic myocardial damage alone, making the diagnosis of postoperative (type 5) myocardial infarction challenging. Previous studies have demonstrated that cardiac troponin is related to left ventricular mass, but this correlation was not investigated after cardiac surgery. We aimed to study a possible correlation between postoperative cardiac troponin levels and left ventricular mass index in patients who underwent cardiac surgery to refine the diagnosis of type 5 myocardial infarction, but observed no such correlation regardless of preoperative troponin levels or surgery type.

Salivary cardiac troponin does not correlate with serum levels

Introduction

Several studies suggest a potential correlation between troponin levels detected in serum and saliva. However, prior investigations have not adequately addressed the critical aspect of collecting samples upon admission, which is essential for timely troponin level determination. This study aimed to evaluate the relationship between troponin levels in serum and saliva among patients admitted for chest pain evaluation.

Methods

This observational study was conducted at the Interventional Cardiology Department of the University Medical Center HCMC. Patients presenting with chest pain were enrolled, and unstimulated saliva samples were collected using the Navazesh method simultaneously with the initial blood collection. These samples were then analyzed for levels of salivary troponin I, serum troponin I, and serum high-sensitive troponin T.

Results

Among the 48 patients included, 22 (46%) exhibited myocardial injury, while 12 (25%) were diagnosed with acute myocardial infarction. No significant difference was observed in salivary troponin I levels between the non-myocardial injury and myocardial injury groups (p = 0.425). Moreover, no correlation was found between salivary troponin I levels and either serum troponin T or serum troponin I levels (Pearson correlation p = 0.761, 0.500; Spearman correlation p = 0.857, 0.136, respectively). The ROC curve for salivary troponin I in predicting myocardial injury displayed an AUC of 0.566 (95% CI: 0.402-0.731), indicating poor discriminatory power.

Conclusions

In our investigation, salivary troponin I failed to demonstrate a meaningful correlation with serum troponins, thereby limiting its practical utility in diagnosing myocardial injury or myocardial infarction. Further research is warranted to explore its diagnostic reliability and clinical applicability.

Usefulness of FFR-CT to exclude haemodynamically significant lesions in high-risk NSTE-ACS

BACKGROUND

Coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) derived from CCTA (FFR-CT) may provide a means of reducing unnecessary invasive coronary angiography (ICA) in patients with suspected non-ST-elevation acute coronary syndromes (NSTE-ACS).

AIMS

The aim of this study was to evaluate the capacity of FFR-CT and CCTA to rule out significant lesions in high-risk NSTE-ACS patients, using ICA with invasive FFR as the gold standard.

METHODS

High-risk NSTE-ACS patients admitted to 4 European centres were enrolled in this single-arm, prospective core lab-adjudicated study. Patients underwent CCTA with FFR-CT analysis, followed by ICA with invasive FFR.

RESULTS

Out of the 250 initially planned NSTE-ACS patients, 168 were included, of whom 151 (92%) had sufficient CCTA image quality to undergo CCTA and FFR-CT analysis. The median high-sensitivity troponin T level at 1 hour post-hospitalisation was 5.3 (interquartile range: 1.8-18.6) times the upper reference limit. At the patient level, the diagnostic performance of FFR-CT was numerically higher as compared to CCTA though not statistically significant (sensitivity: 94% vs 93%, specificity: 63% vs 54%, positive predictive value: 83% vs 79%, negative predictive value: 85% vs 80% and accuracy: 83% vs 79%; p=0.58), suggesting an enhanced capability to avoid unnecessary ICA. At the lesion level, the ability of FFR-CT to detect significant lesions was significantly better than that of CCTA (receiver operating characteristic curves: 0.84 vs 0.65 respectively; p<0.01).

CONCLUSIONS

In patients with high-risk NSTE-ACS, FFR-CT offers better diagnostic accuracy - though not statistically significant - and a higher ability to rule out haemodynamically significant stenoses as compared to CCTA. This indicates that FFR-CT can reduce unnecessary invasive procedures by more accurately identifying patients requiring further intervention.