OBJECTIVE:Coronary artery perforation (CAP) is a rare but potentially catastrophic complication of percutaneous coronary intervention (PCI). We describe a prespecified candidate recognition pattern - the perforation triad - that may help operators identify an evolving perforation during inflation. METHODS:In this single-center retrospective matched case-control study, 9865 PCI procedures performed between 2020 and 2025 were screened. Forty-one balloon- or stent-related Ellis II-III CAP cases (0.42%) were matched 1: 1 by age, sex, American College of Cardiology/American Heart Association lesion class, and rotational atherectomy use with uncomplicated PCI controls, each contributing one stage-matched index inflation. The triad - chest or back pain during inflation, abrupt balloon-waist disappearance without balloon rupture, and ventricular extrasystole temporally linked to inflation - was prespecified before data abstraction and adjudication. Prespecified descriptive analyses covered the three components, their pairwise combinations, and component-count thresholds; no threshold optimization was undertaken. RESULTS:Among CAP cases, components were present in 78.0, 85.4, and 73.2%, respectively; the complete triad in 28 of 41 cases (68.3%; 95% confidence interval: 51.9-81.9) and in 0 of 41 selected control inflations. Control inflations meeting the pattern fell as more components were required (≥1, 20 of 41; ≥2, 10 of 41; triad, 0 of 41), with case-level sensitivity of 87.8, 80.5, and 68.3%. Tamponade requiring drainage occurred in 29.3%, and in-hospital mortality was 7.3%. CONCLUSION:The perforation triad is a plausible recognition pattern for balloon- or stent-related Ellis II-III CAP. Because of retrospective sampling, selected controls, and incorporation bias, it should not be interpreted as a validated diagnostic rule or as evidence of real-world specificity; prospective inflation-level validation is required.
Background and aims Insulin resistance and systemic inflammation are key drivers of atherosclerosis but are typically evaluated separately. This study aimed to determine whether integrating the triglyceride-glucose (TyG) index with inflammatory markers improves long-term risk stratification for major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD). Methods and results In this prospective cohort study, 9316 CAD patients were followed for 10 years. Cox regression models were used to assess associations between the TyG index and inflammatory markers with MACE. Incremental predictive value was evaluated using net reclassification improvement (NRI) and integrated discrimination improvement. The combined TyG-inflammation models were significantly associated with an increased risk of 10-year MACE, corresponding to a 19.1% relative increase in hazard. Among the evaluated models, the TyG + systemic inflammation response index (SIRI) combination demonstrated the most consistent performance, primarily through improving risk reclassification rather than discrimination. The model achieved an NRI of 5.5% for overall MACE and 15.4% for cardiac death, indicating improved identification of high-risk patients who would not be detected by the TyG index alone. Conclusion Integrating systemic inflammation, particularly SIRI, with the TyG index significantly enhances long-term cardiovascular risk reclassification in CAD patients. This simple and cost-effective approach based on routine laboratory parameters may improve risk stratification and support more targeted secondary prevention.
Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Beyond recurrent ischemic events, many patients experience a sustained and gradual reduction in physical activity and functional capacity after diagnosis, hospitalization, and treatment. Deconditioning is a complex process that encompasses physiological and behavioral decline driven by inactivity, symptoms, fear-avoidance behaviors, and treatment-related factors. It provides a unifying condition through which these deficits can be understood and targeted. Although exercise-based cardiac rehabilitation is a cornerstone of secondary prevention, deconditioning is rarely measured explicitly in clinical practice or treated as a reportable outcome in CAD studies and clinical pathways. In this narrative review, we aim to refine the contemporary definition of deconditioning as it applies to CAD, and we summarize drivers of deconditioning across the CAD continuum (stable angina, acute coronary syndromes, and postrevascularization care). Furthermore, we discuss clinical consequences, including impaired quality of life, hospital readmission risk, and reduced participation, in evidence-based therapies. Finally, this review proposes a pragmatic research and implementation agenda to incorporate objective activity/functional endpoints and early patient mobilization strategies into routine CAD care. Treating deconditioning as a modifiable, patient-oriented outcome may improve recovery after adverse coronary events and might offer a platform that aligns coronary revascularization and pharmacotherapy decisions with what matters to patients the most. This includes the absence of ischemic symptoms, recovery of functional capacity, and return to usual leisure and work activities.
OBJECTIVE:To describe prenatal evaluation and postnatal outcome of monochorionic diamniotic twins with discordant anomalies and genetic findings after intracytoplasmic sperm injection and double-embryo transfer. METHODS:A 36-year-old gravida 3 para 0 woman conceived after transfer of two blastocysts. Ultrasound identified monochorionic diamniotic twins and a liver-containing omphalocele in fetus B. Both sacs underwent separate amniocentesis. Testing included karyotyping, chromosome microarray, Beckwith-Wiedemann syndrome analysis, trio whole-exome sequencing, short tandem repeat analysis, postnatal peripheral blood fluorescence in situ hybridization, and placental histopathology. RESULTS:Fetus A had mosaic 45,X[9]/46,XY[91]; fetus B had a 46,XY karyotype. Other prenatal genetic tests were unremarkable. Discordance at 11 of 21 short tandem repeat loci supported dizygosity. Following prelabor rupture of membranes at 34 + 5 weeks, two male infants were delivered by cesarean section. Twin A had hypospadias and bilateral cryptorchidism; twin B had giant omphalocele requiring surgical repair. Postnatal fluorescence in situ hybridization detected no sex-chromosome mosaicism. Placental histopathology confirmed monochorionicity. CONCLUSION:Monochorionicity does not exclude dizygosity after assisted reproduction. Separate sampling of both sacs may inform discordant cases, and prenatal-postnatal discrepancies in 45,X/46,XY mosaicism warrant cautious longitudinal interpretation.
BACKGROUND:Head-to-head comparisons of contemporary drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) remain limited. We sought to compare the long-term clinical outcomes of four widely used DES platforms: Orsiro, Xience, Synergy, and Resolute. METHODS:From the nationwide prospective Korea acute myocardial infarction registry-V, we identified 9284 patients with AMI undergoing percutaneous coronary intervention with one of the four study devices (Orsiro, n = 1634; Xience, n = 2576; Synergy, n = 2811; Resolute, n = 2263). The primary endpoint was target lesion revascularization (TLR). Inverse probability of treatment weighting was performed to adjust for baseline differences. RESULTS:During a median follow-up of 723 days, the cumulative incidence of TLR differed significantly among groups. In IPTW-adjusted analyses, compared with the Orsiro group (reference), the risk of TLR was significantly higher in the Synergy [hazard ratio: 2.30; 95% confidence interval (CI): 1.20-4.41, P = 0.013] and Resolute groups (hazard ratio: 2.30, 95% CI: 1.18-4.47, P = 0.014). The Xience group showed a comparable risk of TLR to Orsiro (hazard ratio: 1.40, 95% CI: 0.69-2.82, P = 0.346). Target vessel revascularization followed a similar pattern, favoring Orsiro. However, there were no significant differences in composite major adverse cardiovascular events or all-cause mortality among the four groups. CONCLUSION:In this large-scale, real-world AMI cohort, the ultrathin-strut, biodegradable-polymer Orsiro stent was associated with a lower risk of repeat revascularization compared with the Synergy and Resolute stents. Xience demonstrated comparable outcomes to Orsiro. Stent selection remains a crucial determinant of vessel-level outcomes in patients with AMI.
BACKGROUND:Guidelines recommend 12 months of potent P2Y12 inhibitor-based dual antiplatelet therapy after acute myocardial infarction-drug-eluting stents (AMI-DES) percutaneous coronary intervention, but the optimal strategy beyond 1 year remains unclear. We evaluated the clinical impact of de-escalating from prasugrel to clopidogrel at the 12-month landmark. METHODS:Using the nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health registry, we identified AMI patients who underwent successful percutaneous coronary intervention with DES and remained event free on aspirin-prasugrel (ASA/PSG) for 12 months. Patients were categorized into those who continued ASA/PSG or de-escalated to aspirin-clopidogrel (ASA/CPG). The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke during months 12-24. Propensity score matching was used to adjust for confounders. RESULTS:Among 967 eligible patients, 384 continued ASA/PSG and 304 de-escalated to ASA/CPG. In the unmatched cohort, the cumulative incidence of the primary endpoint was lower in the ASA/CPG group (log-rank P = 0.045). In the propensity score matching cohort (250 pairs), there were no significant differences between the ASA/CPG and ASA/PSG groups for the primary endpoint (P = 0.316) or the secondary composite (P = 0.378). Absolute event rates were notably low in both groups; specifically, no definite/probable stent thrombosis or major bleeding occurred during the second year. Propensity score-adjusted Cox models confirmed these neutral findings (hazard ratio: 1.06, 95% confidence interval: 0.52-2.12). CONCLUSION:In stabilized AMI-DES survivors, de-escalating to clopidogrel at 12 months showed no significant difference in observed clinical outcomes compared with continued prasugrel, alongside a favorable safety profile. These findings suggest that clopidogrel-based de-escalation may be a reasonable step-down strategy in the second year, aligning with personalized therapy recommendations.
BACKGROUND:New-onset atrial fibrillation (NOAF) following ST-segment elevation myocardial infarction (STEMI) is associated with increased morbidity and mortality. Magnesium (Mg), a key regulator of cardiac electrophysiology, has been implicated in arrhythmogenesis; however, its predictive value for NOAF in STEMI remains unclear. METHODS:This retrospective study included 2426 consecutive STEMI patients who underwent primary percutaneous coronary intervention (p-PCI). Patients were categorized based on the occurrence of NOAF during hospitalization. Clinical, laboratory, and procedural data were compared between groups. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors and determine the optimal Mg threshold for NOAF. RESULTS:NOAF occurred in 109 (4.5%) patients. Patients with NOAF had significantly lower serum Mg levels (median: 1.70 vs. 2.10 mg/dl; P < 0.001) and a higher proportion of Killip Class greater than 1. ROC analysis identified a Mg threshold of less than 1.88 mg/dl for predicting NOAF (area under the curve: 0.757; sensitivity: 71.5%, specificity: 78.1%). Low Mg was an independent predictor of NOAF in multivariable logistic regression analysis (odd ratio: 2.45; 95% confidence interval: 1.60-4.14; P = 0.007). CONCLUSION:Admission serum Mg level is an independent predictor of NOAF in STEMI patients undergoing p-PCI. Mg assessment may support risk stratification and guide preventive strategies.
