Objectives Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease is technically demanding if there is a concomitant chronic total occlusion (CTO) of the right coronary artery (RCA). Which vessel to be revascularized in first attempt was not evaluated before. Methods We included 32 845 patients who received coronary angiography in Taipei Veterans General Hospital between January 2011 and December 2020. A total of 135 patients had both LMCA disease and RCA CTO. We compared two revascularization strategies of recanalization: one that revascularized the RCA CTO first and one that received LMCA PCI first. Results A total of 107 patients received revascularization of the LMCA first, and 28 patients received RCA CTO PCI first. There was no difference in periprocedural (cardiogenic shock and cardiac tamponade) (18 vs. 20%; P = 1.000 and 0 vs. 2%; P = 1.000, respectively) and in-hospital complications (acute kidney injury, acute respiratory failure, and in-hospital mortality) (7 vs. 7%; P = 1.000, 0 vs. 6%; P = 0.343, and 7 vs. 7%; P = 1.000, respectively). Three-year major adverse cardiocerebrovascular event (MACE) was not statistically different between the two groups (18 vs. 25%; P = 0.197). Three-year MACE was statistically significantly lower in the complete revascularization group (both LMCA PCI and successful RCA CTO PCI) than in the partial revascularization group (LMCA PCI only) (16 vs. 28%; P = 0.017). Conclusion In patients with LMCA disease and concomitant RCA CTO, LMCA PCI did not differ from RCA CTO PCI in the first attempt in terms of periprocedural, in-hospital, 3-year all-cause mortality, and 3-year MACE.
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.
