Background Chronic coronary syndrome (CCS) is a dynamic process, and stable coronary artery plaques can progress over time and lead to ischemia. Early detection of these patients is of great importance for closer monitoring and optimization of treatment. In this study, we investigated the usefulness of the HALP score in predicting progression to critical coronary artery disease (CAD) in patients with noncritical stenosis detected by fractional flow reserve (FFR). Methods A total of 181 patients who were followed up due to CCS and whose FFR value was > 0.8 and who were decided to be followed up medically were included in the study. This is a retrospective cohort study. Patients were followed up through hospital records after the FFR date. Patients were divided into two groups for analysis: those who did not progress to critical CAD (Group 1) and those who did (Group 2). The HALP score was calculated according to the formula: hemoglobin (g/L) × albumin (g/L) × lymphocytes (10 9 /L)/platelets (10 9 /L). Results Of the 181 patients included in the study, 111 (61.3%) were male. The mean age of these patients was 60.3 ± 10.6 (min: 26, max: 83) years. Of the coronary arteries undergoing FFR, 126 (69.6%) were LAD, 20 (11.1%) were CX, and 35 (19.3%) were RCA. The mean follow‐up period after FFR was 19.9 ± 10.6 months. The mean HALP score was significantly lower in Group 2 (64.9 ± 34.8 vs 46.4 ± 18.9, p = 0.002). Cox regression analysis demonstrated low preadenosine FFR (hazard ratio [HR]: 0.897; 95% confidence interval [CI]: 0.818–0.984; p = 0.022), and low HALP score (HR: 0.980; 95% CI: 0.967–0.994; p = 0.004) as independent predictors of PCI requirement during follow‐up. As a predictor of PCI requirement during follow‐up, the ROC curve analysis revealed a sensitivity of 65% and specificity of 61% for HALP score < 50.5 (area under the curve [AUC] 0.673, 95% CI: 0.582–0.764, p = 0.001). Conclusion Low HALP score may be a predictor of progression of noncritical coronary artery plaques in patients with CCS.
Background Left main coronary artery disease in patients with significant left ventricular (LV) dysfunction is associated with elevated procedural risk for both surgical and percutaneous interventions. Mechanical circulatory support is increasingly used empirically for high‐risk percutaneous coronary interventions (PCI), but availability remains limited in many catheterisation laboratories. We report outcomes of unprotected left main PCI (LM‐PCI) in patients with moderate‐to‐severe LV dysfunction (LVEF ≤ 35%) performed without routine periprocedural mechanical support over 15 years at a tertiary New Zealand centre. Methods Patients undergoing unprotected LM‐PCI at North Shore Hospital between December 2007 and September 2023 were retrospectively identified. Baseline demographics, procedural characteristics, and outcomes were collected. Primary outcomes included in‐hospital mortality, 30‐days mortality, and 1‐year all‐cause mortality. Secondary outcomes were major adverse cardiovascular events (MACE) within 1 year, including cardiogenic shock, myocardial infarction, stroke, target vessel revascularisation, and procedural complications. Results Seventy‐four eligible cases were analysed for this study. Median age was 72 years. 74.3% had severely impaired LVEF of 30% or less. Indications for coronary intervention included NSTEMI (41.9%), cardiomyopathy (28.4%), STEMI (8.1%), and cardiac arrest (9.5%). In‐hospital mortality was seen in 1 patient (1.4%), with no death at 30 days. One‐year mortality was 8.1%. Total MACE outcomes at 1‐year occurred in 3 patients (4.4%); all myocardial infarction, and 1 of these patients (1.5%), had target vessel revascularisation. Conclusion In our retrospective single‐centre analysis, we found low rates of mortality and MACE, in unprotected LM‐PCI cases without periprocedural mechanical haemodynamic support, in patients with moderate to severely impaired LVEF. These data suggest that careful patient selection and procedural planning may allow safe LM‐PCI in high‐risk patients even when mechanical circulatory support is not available.
Background Current guidelines favor Coronary Artery Bypass Graft (CABG) Surgery over Percutaneous Coronary Intervention (PCI) for multivessel (MVD) and left main coronary artery disease (LM‐CAD) due to better outcomes. However, the FAME‐3 trial suggests similar long‐term results between PCI and CABG for triple‐vessel disease. To explore this discrepancy, we conducted a systematic review and meta‐analysis of randomized controlled trials comparing CABG and PCI with DES, assessing differences in all‐cause mortality, target vessel revascularization (TVR), and major adverse cardiovascular and cerebrovascular events (MACCE) over at least 3 years. Methods RCTs comparing CABG with PCI, reporting outcomes on at least 3 years (36 months) of follow‐up, were included. Using an Intention‐to‐treat analysis, the primary outcome was assessed as the relative risk of all‐cause mortality, while secondary outcomes consisted of TVR and MACCE. We also performed subgroup analysis based on the type of coronary artery disease (LM‐CAD or MVD) and SYNTAX scores. Results CABG did not show any significant benefit in terms of all‐cause mortality when compared to PCI for either LM‐CAD or MVD (RR: 0.90, 95% CI: 0.78, 1.04). It had a lower risk of all‐cause mortality in patients with SYNTAX < 23 and a lower risk of MACCE (RR: 0.75, 95% CI: 0.70, 0.81) and TVR (RR: 0.50, 95% CI: 0.38, 0.66) across all subgroups regardless of the SYNTAX score. Conclusions While no major mortality difference was noted between CABG and PCI, the risk of MACCE and TVR was lower with CABG in both LM‐CAD and MVCAD across all SYNTAX scores. This should be discussed at length with patients, as it may impact decision‐making.
Background Rapid pacing is required during transcatheter aortic valve implantation (TAVI) to facilitate valve deployment. Conventional right ventricular (RV) temporary pacing requires transvenous lead placement and has been associated with mechanical complications, including cardiac perforation. Left ventricular (LV) guidewire pacing has emerged as an alternative strategy that may avoid lead‐related injury. We performed a systematic review and meta‐analysis to compare clinical and procedural outcomes between LV guidewire pacing and RV temporary pacing during TAVI. Methods MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched through February 15, 2026. Comparative studies evaluating LV guidewire pacing versus RV temporary pacing during TAVI were included. The primary endpoint was global cardiac tamponade. Prespecified mechanistic analyses evaluated pacing lead‐related and annular rupture‐related tamponade. Secondary endpoints included all‐cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), stroke, major vascular complications, bleeding, permanent pacemaker implantation, and procedural metrics. Random‐effects meta‐analyses were performed using Mantel–Haenszel models. Results Five studies (one randomized controlled trial and four observational cohorts) comprising 2840 patients (1910 LV and 930 RV) were included. Global cardiac tamponade occurred in 1.1% of LV patients and 2.5% of RV patients (OR 0.45; 95% CI 0.18–1.16; p = 0.08). In mechanistic analyses, pacing lead‐related tamponade was significantly reduced with LV pacing (OR 0.09; 95% CI 0.02–0.56; p = 0.03), whereas annular rupture‐related tamponade did not differ between strategies. The pooled absolute risk reduction for pacing lead‐related cardiac tamponade was approximately 1.2%, corresponding to an estimated number needed to treat of 83. A signal toward lower all‐cause mortality was observed in pooled analyses, largely driven by observational cohorts. Major vascular complications and bleeding showed nonsignificant trends favoring LV pacing. Permanent pacemaker implantation did not differ significantly between strategies. LV pacing was associated with shorter procedural duration (mean difference −5.83 min; 95% CI −7.08 to −4.58; p < 0.001). Conclusions LV guidewire pacing during transfemoral TAVI was associated with a lower risk of pacing lead‐related cardiac tamponade and shorter procedural duration. This benefit appears to be mechanism‐specific and should not be extrapolated to annular rupture or other nonlead‐related causes of tamponade. Although LV guidewire pacing may simplify procedural workflow, its use should be individualized according to baseline conduction risk and the availability of rapid bailout pacing strategies.
Background: Third-degree atrioventricular (AV) block following transcatheter aortic valve replacement (TAVR) often necessitates permanent pacemaker (PPM) implantation. However, the impact of PPM timing on clinical outcomes remains unclear. Methods: Utilizing the National Inpatient Sample (2016-2021), we identified third-degree AV block patients who received PPM during the same admission period after TAVR. Cohorts were defined as early (<= 72 h) or delayed (> 72 h) implantation. In-hospital mortality constituted the primary endpoint, while the duration of hospitalization and the costs incurred were designated as secondary endpoints. Multivariable logistic regression was employed to calculate adjusted odds ratios (aOR) or adjusted beta (a beta). Results: In an adjusted analysis of 3385 patients exhibiting third-degree AV block post-TAVR who underwent PPM implantation, no significant variation in in-hospital mortality was detected between the two cohorts (aOR 1.25, 95% CI 0.59-2.66), but the delayed group experienced a 6.30-day longer LOS (a beta: 6.30; 95% CI, 5.96-6.63) and incurred $81,572.80 more in hospitalization costs (a beta: 81,572.8; 95% CI 69,542.5-93,606.1). Delayed PPM implantation was more likely in patients with anemia, coagulation disorders, congestive heart failure, or chronic kidney disease (all p < 0.001). Conclusion: In this national cohort, delayed PPM implantation after TAVR-related AV block was associated with longer stays and higher costs, but not with mortality. This delay was more frequent among patients with baseline hematological and cardiorenal dysfunction.
This perspective explores the contemporary role of CTO PCI proctorship in LMICs, focusing on structural constraints, operator heterogeneity, recurrent procedural pitfalls, human factors, and ethical considerations. We propose a regionalized, center-focused model as a more sustainable strategy for capacity building, patient safety, and long-term program development. Although grounded in Latin American experience, the structural challenges and proposed solutions are broadly applicable to any setting where procedural complexity outpaces institutional readiness.
Rotational atherectomy (RA) is an established technique for the treatment of heavily calcified coronary artery disease. Severe coronary calcification remains a frequent cause of procedural difficulty and device delivery failure during complex percutaneous coronary intervention (PCI). Delivery of the atherectomy burr to the target lesion may be particularly challenging in the presence of limited guide support, proximal vessel tortuosity, or unfavorable coronary anatomy that restricts safe access to distal calcified segments. Guide extension catheters (GECs) are widely used to enhance guide support and improve coaxial alignment during complex PCI. However, their use in combination with RA represents an advanced and selectively applied strategy that is not routinely addressed in conventional atherectomy training and is often avoided because of concerns regarding device interaction and difficulties during burr delivery and retrieval. Despite increasing anecdotal use in complex PCI, the technical principles and procedural safety considerations of performing RA through GECs remain insufficiently described in the literature. This review provides a focused technical overview of RA performed through GECs. We summarize the rationale for this approach, describe key technical considerations including device compatibility and burr advancement strategies, and discuss practical measures to minimize procedural complications. In addition, we outline clinical scenarios in which this technique may be beneficial, as well as situations where it should be avoided. Rather than advocating routine use, this review aims to define the role of guide extension–facilitated RA as a selective strategy for highly complex coronary anatomies.
Introduction Percutaneous pulmonary valve implantation (PPVI) has been approved for the management of the dysfunctional pulmonary valve (PV) and right ventricular outflow tract (RVOT). The study aimed to evaluate the feasibility, safety, and efficacy of the balloon-expandable valves in PPVI for the management of dysfunctional different RVOTs with pulmonary stenosis (PS) and/or pulmonary regurgitation (PR) and to compare PPVI between RV-PA conduits/bioprosthetic PVs and native/patched RVOTs regarding the preprocedure, procedural, postprocedural characteristics, and long-term outcome. Methods All patients who underwent PPVI for dysfunctional different RVOTs using balloon-expandable valves, either Melody or Sapien S3 valves, from May 2017 to January 2025 were included. Results Forty-two patients underwent PPVI; 24 (57.1%) had RV-PA conduits/bioprosthetic PVs, and 18 (42.9%) had native/patched RVOTs. The mean age and weight were 29.9 +/- 13.7 years and 65.4 +/- 23.6 kg, respectively. Cardiac MRI revealed the RVEDVI of 144.9 +/- 32.9 mL/m(2), RVEF of 48.6 +/- 7.1%, and PV-Pg of 33.5 +/- 20.3 mmHg. Three (7.1%) patients with bioprosthetic PVs underwent direct valve implantation; 21 (50.0%) patients required 1 stent, 15 (35.7%) required 2 stents, and 2 (4.8%) from the native/patched RVOT group required the Russian Doll technique. The Melody valve was implanted in 7 (16.7%) patients, and the Edwards Sapien S3 valve was implanted in 35 (83.3%) patients. Larger balloons, longer and multiple stents, with larger valves were required in native/patched RVOTs (p < 0.001(& lowast;)). All patients reported technical success, with mean procedural and fluoroscopy times of 56.7 +/- 6.9 and 37.8 +/- 7.3 min. No patient suffered coronary impingement with a total in-hospital stay of 2.3 +/- 1.0 days, without recorded mortality. Conclusions PPVI using balloon-expandable valves is a feasible and safe method for managing dysfunctional RVOTs: RV-PA conduits, bioprosthetic PVs, native, and patched RVOTs. However, preprocedural characteristics, procedural strategies, technical approaches, valve sizing methods, materials used, and outcomes vary according to the RVOT anatomy.
BackgroundThe optimal catheter ablation strategy for non-paroxysmal atrial fibrillation (non-PAF) is controversial. We examined the safety, feasibility, and efficacy of a new treatment strategy for non-PAF, defined as the Pulmonary vein isolation (PVI); left roof linear (RL), Mitral Isthmus linear (MIL), and left anterior SEptal linear (ASL) ablation; and leftatrial appendage (LAA) Device occlusion (PROMISED) procedure. MethodsOne-hundred forty-two patients with non-PAF underwent PVI + RL + ASL ablation with/without MIL ablation, combined with LAA occlusion (LAAO). The primary end point was atrial arrhythmia recurrence after a 3-month blanking period. ResultsEighty-two patients underwent the PROMISED procedure (MIL group) and 60 patients underwent PVI + RL + ASL ablation with LAAO without MIL ablation (Non-MIL group). The baseline characteristics were similar between the two groups. No serious procedure-related complications occurred during the procedure. Twelve months after a single procedure, atrial arrhythmia recurrence was observed in 17/82 patients (20.7%) in the MIL group versus 31/60 patients (51.7%) in the Non-MIL group (hazard ratio [HR]: 0.327 and 95% confidence interval [CI]: 0.181-0.592; p < 0.001). No peridevice leak > 5 mm was observed during the 12-month follow-up. Overall, 85.2% of the patients discontinued oral anticoagulant therapy within 6 months after the procedure. One patient experienced stroke in the MIL group 10 months after the procedure and one experienced stroke in the Non-MIL group 2 months after the procedure. ConclusionIn patients with non-PAF, the MIL group, which underwent the PROMISED procedure, was associated with a lower observed 12-month atrial arrhythmia recurrence rate without an apparent increase in complications.
BackgroundIn-stent restenosis (ISR) remains challenging after percutaneous coronary intervention (PCI) using drug-eluting stents, often leading to target lesion revascularization (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs). Excimer laser coronary atherectomy (ELCA) removes neointimal tissue and preserves minimum lumen area (MLA); however, its long-term benefits are unclear.AimsWe assessed the 3-year outcomes of PCI with or without ELCA for ISR and examined prognostic factors and intravascular ultrasound (IVUS) findings.MethodsWe retrospectively analyzed data of 97 patients with ISR among 2083 consecutive patients who underwent PCI between April 2020 and March 2025. Patients were divided into ELCA (n = 44) and non-ELCA (n = 53) groups. Outcomes were analyzed using Kaplan-Meier and log-rank tests. The primary outcome was all-cause mortality. Secondary outcomes included TLR and MACCE rates. IVUS characteristics were also assessed.ResultsBaseline characteristics were generally similar between groups, although acute coronary syndrome was more frequent in the non-ELCA group. All-cause mortality did not differ significantly between groups (p = 0.699). TLR was numerically lower in the ELCA group (0% vs. 7.5%, p = 0.062). MACCEs were significantly less frequent in the ELCA group (2.3% vs. 18.9%, p = 0.018), and ELCA was independently associated with a lower risk of MACCEs in multivariable Cox analysis. After IPW, ELCA remained significantly associated with a lower risk of MACCEs (odds ratio 0.065, 95% confidence interval 0.006-0.291, p = 0.003). However, event-specific analyses, particularly for TLR, were limited by sparse events and should be interpreted cautiously. IVUS showed significantly greater lumen enlargement in the ELCA group, and the change in MLA correlated with baseline minimum stent area only in the ELCA group.ConclusionsIn this retrospective cohort, ELCA was associated with lower MACCE rates and greater lumen enlargement; however, these findings should be considered hypothesis-generating in light of the nonrandomized design, limited sample size, and imbalance in clinical presentation.
Background Acute coronary syndrome (ACS) is a major cause of morbidity and mortality, and early diagnosis remains challenging. Stress- and inflammation-related biomarkers such as copeptin and neopterin may improve diagnostic and prognostic assessment. This study aimed to evaluate serum levels of copeptin and neopterin in patients with ACS compared with controls. Methods In this case-control investigation, a total of 130 patients diagnosed with ACS were included, comprising 54 individuals with ST-segment elevation myocardial infarction (STEMI), 26 with non-ST-segment elevation myocardial infarction (NSTEMI), and 50 with unstable angina pectoris (UAP). Additionally, 82 control subjects were recruited, consisting of 42 with stable angina pectoris (SAP) and 40 without any cardiac conditions (NCD). Blood samples were obtained alongside demographic information, and serum concentrations of neopterin and copeptin were quantified utilizing the ELISA technique. Results Serum copeptin concentrations were notably greater in the ACS patients (132.73 +/- 325.88 ng/mL) in comparison to the control group (87.22 +/- 218.36 ng/mL,p < 0.001). Similarly, serum neopterin levels were elevated in ACS patients (5.57 +/- 8.92 ng/mL) compared with controls (1.95 +/- 6.96 ng/mL, p < 0.001). Among the ACS subgroups, STEMI patients exhibited the highest copeptin (and neopterin) levels, whereas the NCD group had the lowest values (p = 0.001 for copeptin and p = 0.029 for neopterin). The multivariable logistic regression analysis indicated that smoking cigarettes (OR = 4.115, 95%CI: 1.759-9.625), levels of copeptin (OR = 1.013, 95%CI: 1.008-1.018), and neopterin concentrations (OR = 1.316, 95%CI: 1.112-1.558) were notably linked to a heightened risk of ACS. Conclusion Serum levels of neopterin and copeptin are markers of ACS presence and provide valuable information regarding disease severity and prognosis. These biomarkers may be effectively used alongside conventional markers to improve early diagnosis and guide therapeutic strategies in ACS patients.
BackgroundPrevious studies have suggested site-specific differences in lesion distribution and risk factor profiles in peripheral artery disease (PAD). However, these associations have not been systematically evaluated within a broader framework incorporating disease extent, clinical severity, and systemic vascular involvement.MethodsWe conducted a retrospective cohort study of 3548 patients with lower extremity PAD. Lesion distribution was classified as aortoiliac (AI), femoropopliteal (FP), or infrapopliteal (IP) in patients with single-site disease, while disease extent was defined as single-site versus multisite involvement (>= 2 segments). Ordinal logistic regression was used to assess associations with lesion distribution and multivariable logistic regression to evaluate disease extent, clinical severity, and vascular comorbidities. Stratified and sensitivity analyses were performed.ResultsDistinct patterns of association were observed across multiple dimensions of PAD, including lesion distribution, disease extent, and clinical severity. Age and diabetes were strongly associated with distal lesions, whereas smoking was associated with proximal disease. Lipid-related variables showed heterogeneous associations that varied across individual lipid measures and were modified by diabetes status and age. In contrast, disease extent was more strongly associated with smoking and hypertension, but not diabetes. Disease extent, as reflected by multisite involvement, was independently associated with increased disease severity and a higher prevalence of cerebrovascular disease (CeVD), indicating a greater systemic atherosclerotic burden.ConclusionsCardiovascular risk factors exhibit differential associations across multiple dimensions of PAD, including lesion distribution, disease extent, and clinical severity. These findings highlight the multidimensional and heterogeneous nature of PAD and support more individualized, site-specific approaches to risk assessment and management. In particular, these findings suggest the potential value of tailoring risk factor control according to lesion characteristics, such as emphasizing smoking cessation in proximal disease and optimizing glycemic control in distal disease.
BackgroundApixaban is commonly used in anticoagulation therapy. Its safety profile is associated with polypharmacy and potential drug-drug interactions (DDIs). Current understanding often focuses on canonical metabolic pathways, while other biological factors of haemorrhagic risk remain not fully described.ObjectivesThis study investigated DDI signal drugs associated with haemorrhagic adverse events when apixaban is used with concomitant drugs. The study also explored potential pharmacological mechanisms.MethodsA disproportionality and DDI signal analysis was performed on FDA Adverse Event Reporting System (FAERS) data from the first quarter of 2013 to the first quarter of 2025. DDI signals were identified using six different algorithms. A DDI signal met the analysis criteria if it was detected by all six algorithms including the Omega shrinkage method and the chi-square test. Concomitant drugs associated with DDI signal drugs were classified using the DrugBank database to investigate pharmacological properties with a focus on metabolic enzymes and transporters.ResultsAfter the exclusion of established interactions, the analysis identified 107 medications and 49 preferred terms. Analysis at the level of enzymes and transporters indicated that noncanonical pathways exhibited risk intensities, including arylsulfatase A (ARSA, weighted mean Omega = 3.60), macrophage metalloelastase (MMP12, weighted mean Omega = 3.16), organic anion transporting polypeptide 2B1 (OATP2B1, weighted mean Omega = 2.82) and bile salt export pump (BSEP, weighted mean Omega = 2.62). DDI signal drugs associated with high-intensity targets included acyclovir for duodenal ulcer haemorrhage (Omega = 2.90, 95% CI: 2.12-3.69), mesalazine for an increased tendency to bruise (Omega = 2.96, 95% CI: 1.69-4.22) and digitoxin for haematoma (Omega = 2.65, 95% CI: 1.83-3.46). Interaction signals were also recorded for morphine with injection site haematoma (Omega = 3.05, 95% CI: 1.90-4.21) and eltrombopag with internal haemorrhage (Omega = 3.11, 95% CI: 2.04-4.18).ConclusionHaemorrhagic risks in apixaban therapy are likely associated with a convergence of transport interference, potential impairment of haemostasis and indirect clinical factors, such as medication-induced instability. These findings suggest that safety management may extend beyond canonical pathways to consider the possible impact of alternative transporters and functional stability. These results provide a preliminary basis for further clinical validation.
BackgroundThe Short Physical Performance Battery (SPPB) test not only provides a precise assessment of rehabilitation but also predicts a clinical prognostic outcome. The aim was to establish a prognostic model for patients with acute heart failure (AHF) based on SPPB.MethodsPatients with AHF in Tongji Hospital were screened and enrolled to conduct this retrospective cohort study. Forty-five potential predictor variables were used in univariate and multivariate Cox regression analysis for all-cause mortality. The prognostic model was further built with a nomogram, the accuracy of which was evaluated through the consistency index (C-index), TimeROC curves, calibration curves, and DCA curves.ResultsOf 108 patients with AHF enrolled, the median follow-up time was 454.5 days and all-cause mortality was 53. Multivariate predictors of all-cause mortality included SPPB, hypertension, rehabilitation, and ACEI/ARB/ARNI medications. The nomogram was developed to predict all-cause mortality. Consistency between the predicted and actual values in the 1- and 2-year survival calibration curves was excellent, with a C-index of 0.748. TimeROC AUCs were 0.796 and 0.807 in predicting the 1- and 2-year survival. The DCA curves indicated a higher net clinical benefit compared to the null model.ConclusionsThis study demonstrated that SPPB, hypertension, rehabilitation, and ACEI/ARB/ARNI medications were independently associated with all-cause mortality in patients with AHF. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR-TNRC-08000235ConclusionsThis study demonstrated that SPPB, hypertension, rehabilitation, and ACEI/ARB/ARNI medications were independently associated with all-cause mortality in patients with AHF. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR-TNRC-08000235
Background High thrombus burden (HTB) during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is associated with adverse outcomes. Low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerosis, but its direct role in acute thrombus formation remains unclear. Methods This single-center observational study enrolled 236 consecutive STEMI patients undergoing primary PCI at our institution between November 2022 and July 2025. Thrombus burden was graded angiographically per TIMI criteria (Grades 1-3: low thrombus burden [LTB]; grades 4-5: HTB). Multivariable logistic regression evaluated associations between LDL-C levels and thrombus burden. Restricted cubic spline (RCS) modeling explored potential nonlinear relationships. Stratified analyses assessed result robustness. Results HTB occurred in 78.4% (185/236) of STEMI patients receiving primary PCI. Patients with HTB demonstrated higher prior MI rates (13% vs. 2%, p = 0.024), elevated admission LDL-C (1.8 +/- 1.1 vs. 1.4 +/- 0.9 mmol/L, p = 0.038), increased peak high-sensitivity troponin T (1473.0 vs 718.0 ng/mL, p = 0.004), and longer hospitalization (6.0 +/- 2.8 vs 4.9 +/- 2.2 days, p = 0.007). After adjustment for age, sex, prior MI, systolic blood pressure, hemoglobin, HbA1c, and D-dimer, each 1 mmol/L increment in admission LDL-C was associated with a 48% increased HTB risk (adjusted OR 1.48; 95% CI 1.03-2.13, p = 0.033). Admission LDL-C > 1.8 mmol/L predicted a 2.32-fold higher likelihood of heavy thrombus burden (95% CI 1.04-5.18, p = 0.039). RCS analysis confirmed a linear dose-response association (P for nonlinearity = 0.922). Sensitivity analyses using complete-case data confirmed robustness, and subgroup analyses revealed consistent associations across age, sex, body mass index, smoking status, comorbidities, and lipoprotein(a) levels (all P for interaction > 0.05). Conclusion Elevated admission LDL-C independently correlates with HTB in primary PCI-treated STEMI patients, suggesting LDL-C facilitates prothrombotic pathways during acute coronary syndrome. These findings reinforce LDL-C reduction as a therapeutic approach to mitigate thrombotic complications.
Background: Sedation choice may influence outcomes in acute myocardial infarction (AMI) patients requiring invasive mechanical ventilation (IMV). Dexmedetomidine (DEX) provides arousable sedation with sympatholytic effects and is guideline-endorsed, but data in ventilated AMI patients-particularly for intermediate-term mortality-are limited. Objective: To evaluate the association between early DEX initiation and 90-day all-cause mortality among AMI patients starting IMV. Design, Setting, and Participants: Retrospective cohort and target trial emulation using the MIMIC-IV database. Adults with AMI admitted to the ICU who initiated their first IMV episode within 7 days were included. Time zero (t0) was the start of IMV. Admissions involving cardiac surgery procedures were excluded. The final analytic cohort comprised 2024 patients (266 received early DEX). Exposure: Early DEX, defined as initiation within 24 h after t0, versus no early DEX. Main Outcomes and Measures: The primary outcome was 90-day all-cause mortality from t0. The secondary outcome was ventilator-free days to Day 28 (VFD-28). The primary analysis used a covariate-balancing propensity score (CBPS) with stabilized inverse probability weights and a weighted Cox model with robust, patient-clustered standard errors. Prespecified sensitivity analyses included IPTW-Cox with weight truncation, targeted maximum likelihood estimation (TMLE), 30-day mortality, and exclusion of out-of-hospital cardiac arrest (OHCA). Results: Among 2024 eligible patients, early DEX use was associated with a lower hazard of 90-day mortality (HR 0.572; 95% CI 0.441-0.742; p < 0.001) and more ventilator-free days (mean difference 4.94 days; 95% CI 3.49-6.40; p < 0.001). Sensitivity analyses were directionally consistent, and postweighting covariate balance met prespecified targets. Conclusions: In this target trial emulation of AMI patients requiring IMV, early initiation of DEX within 24 h was associated with lower 90-day mortality and more ventilator-free days. Findings were consistent across multiple analytic approaches and cohort restrictions but remain observational and should not be interpreted as establishing causality. Prospective studies are warranted to confirm causality, define safety boundaries, and guide patient selection.
Background Recent studies have investigated the association between air pollution and ventricular arrhythmias (VAs) with inconsistent results. Therefore, we conducted a systematic review and meta-analysis to elucidate the relationship. Methods We systematically searched PubMed, Embase, and the Cochrane Library. Pooled effects were estimated using random-effects models and expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results This meta-analysis included 22 studies with 784,960 participants, including 15 involving the general population and 7 involving patients with implantable cardioverter defibrillators (ICDs). In the general population, short-term exposure to particulate matter of diameter < 2.5 & micro;m (PM2.5) (OR: 1.02 and 95% CI: 1.01-1.03) was significantly associated with an increased risk of VAs, whereas no significant associations were observed for long-term exposure to PM2.5 (OR: 1.28 and 95% CI: 0.93-1.77) or particulate matter of diameter < 10 & micro;m (PM10) (OR: 1.03 and 95% CI: 0.99-1.07). Additionally, no significant associations were found for short-term exposure to PM10 (OR 1.01, 95% CI 0.68-1.49) or NO2 (OR 0.73, 95% CI 0.32-1.70) with the risk of VAs. Among ICD patients, no significant associations were found between short-term exposure to any pollutant and VAs, including PM2.5 (OR: 1.07 and 95% CI: 0.96-1.18), PM10 (OR: 1.02 and 95% CI: 0.98-1.07), NO2 (OR: 1.04 and 95% CI: 0.97-1.12), O-3 (OR: 1.01 and 95% CI: 0.99-1.03), SO2 (OR: 1.19 and 95% CI: 0.92-1.53), or CO (OR: 1.02 and 95% CI: 0.99-1.05). Conclusion Our meta-analysis indicates that short-term exposure to PM2.5 is associated with an increased risk of VAs in the general population. No significant associations were observed for short-term exposure to any pollutant among ICD patients.
