BACKGROUND:Severe aortic stenosis (AS) and coronary artery disease frequently coexist, yet the optimal management strategy for patients undergoing TAVR with concomitant CAD remains debated. Our study compared safety outcomes and procedural characteristics of concomitant TAVR and PCI versus TAVR alone in a two-center Indian population with severe AS. METHODS:This retrospective, multi-center, case-control study included 30 consecutive patients undergoing planned concomitant TAVR and PCI and 30 age-, sex-, and valve-type-matched TAVR-alone controls identified from the same study period. PCI was performed for angiographically confirmed proximal coronary stenosis ≥70% or as deemed appropriate according to the study protocol. The primary outcome was VARC-3 defined any bleeding or vascular complication through hospital dischargeSecondary outcomes included in-hospital and 30-day mortality, myocardial infarction, stroke, acute kidney injury, pacemaker implantation, fluoroscopy time, and contrast volume. RESULTS:Thirty concomitant TAVR-PCI patients and 30 matched TAVR-alone controls were included. The primary outcome occurred in 3 patients (10.0%) versus 2 patients (6.7%; p>0.99), with a risk difference of 3.3 percentage points (95% CI, -12.7 to 19.7). No major or life-threatening bleeding events occurred. Fluoroscopy time (38.6±23.2 vs. 26.8±10.0 min; p<0.01) and contrast volume (166.7±65.5 vs. 99.6±37.7 mL; p<0.001) were higher with concomitant PCI. No in-hospital or 30-day deaths or myocardial infarctions occurred in either group. CONCLUSION:In this small, retrospective, two-center cohort, concomitant PCI at the time of TAVR was not associated with an observed excess of bleeding or vascular complications compared with TAVR alone. These findings are hypothesis-generating and support the feasibility of a concomitant strategy in carefully selected patients at experienced, high-volume centers; they do not establish safety equivalence.
BACKGROUND:Thromboelastography (TEG) offers real-time evaluation of hemostatic function and holds promise for assessing thrombus burden during ST-segment elevation myocardial infarction (STEMI). This study aimed to validate the diagnostic utility of kaolin-activated TEG in correlating coagulation parameters with angiographic thrombus burden in acute STEMI patients. METHODS:Eighty-one consecutive STEMI patients (age 18-75 years) underwent TEG testing during emergency visit just prior to primay percutaneous coronary intervention (PPCI). Diagnostic validity for TEG indices (R-time, K-time, α-angle, MA, CI, TPI, Ly30) was assessed by sensitivity, specificity, predictive values, and odds ratios. RESULTS:R-time and K-time showed high specificity (96.4% and 85.7%, respectively) and positive predictive values (85.7% and 75%), supporting their use as specific indicators ("SPIN") for thrombus presence. However, sensitivity of all indices was low (R: 12.5%, K: 27.3%), limiting their utility as screening tools. The α-angle and MA displayed moderate specificity (71.4% and 57.7%), with positive predictive values of 60% and 63.3% respectively. The α-angle significantly correlated with higher thrombus grades (p = 0.01), indicating faster fibrin polymerization in more severe cases. Gains in diagnostic knowledge were highest for R-min (23%) and K-min (14%). CONCLUSION:Kaolin-activated TEG, particularly R-time and K-time, demonstrates high specificity but limited sensitivity for identifying high thrombus burden during STEMI. The α-angle remains clinically informative for clot kinetics. While TEG may complement existing assessments for targeted antithrombotic therapy, its greatest utility lies in confirming, rather than screening for, severe thrombus burden. Further prospective studies are warranted to refine its prognostic value (Graphical abstract).
Background Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide. High-throughput omics technologies offer opportunities for more comprehensive understanding of ACS pathophysiology. Methods A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches of PubMed/MEDLINE, Scopus, Web of Science and Embase (January 2015-April 2026) identified 8,731 records. Study quality and risk of bias were assessed for studies selected for detailed evidence synthesis using the Newcastle-Ottawa Scale, QUADAS-2 and AMSTAR-2. Results Systematic searching identified 866 primary studies and 47 systematic reviews. Detailed synthesis focused on the most robust and replicated biomarker candidates where ceramide risk scores, GDF-15, MPO and miR-208a emerged as particularly promising while multi-omics machine-learning models improved ACS classification. Conclusions Multi-omics approaches may enhance precision risk stratification in ACS although prospective validation and standardization remain essential.
