Background The management of malignant ventricular tachycardia (VT) in the aftermath of a myocardial infarction is a complex undertaking, particularly in cases accompanied by left ventricular aneurysm (LVA). It is frequently the case that conventional unipolar radiofrequency catheter ablation (RFCA) is inadequate. Case Summary A 50-year-old male patient with a medical history of myocardial infarction presented with recurrent VT due to a LVA. Initial unipolar RFCA proved to be an ineffective treatment. Bipolar RFCA guided by CARTO mapping during coronary artery bypass grafting has been demonstrated to successfully ablate the LVA. Subsequent postoperative follow-up revealed no recurrence of VT and sustained cardiac function over a 2-year period. Discussion Refractory VT due to LVA poses significant treatment challenges. Bipolar RFCA, guided by CARTO mapping, has been shown to offer an effective solution, overcoming the limitations of unipolar RFCA by targeting both epicardial and endocardial arrhythmogenic substrates. This case demonstrates a surgical approach with the potential to yield favorable outcomes.

Objectives The predictive value of transplant hemodynamic parameters for perioperative cardiovascular events after coronary artery bypass grafting is still unclear, especially for patients with diffuse coronary artery disease. The aim of this study is to evaluate the value of TTFM during coronary artery bypass grafting in predicting adverse cardiovascular and cerebrovascular events in patients with diffuse coronary artery disease after coronary artery bypass grafting, as well as the blood flow and PI of transplanted blood vessels required to avoid perioperative myocardial infarction in different transplant blood supply areas. Based on the above results, we will also discuss the surgical efficacy comparison of endarterectomy and SCVBG in revascularization for patients with diffuse lesions of the right coronary artery Methods In this prospective observational single center study, from February 2020 to June 2024, eligible patients who were continuously enrolled in OPCABG used the handheld flow probe during surgery. TTFM is an imaging system that uses the principle of ultrasound to evaluate the blood flow and patency of cardiovascular surgical grafts. CE is an auxiliary method performed simultaneously in CABG for patients with diffuse coronary artery disease. SCVBG is a method to achieve blood flow reconstruction by retrograde perfusion of myocardium through the coronary vein system. The primary end point is perioperative myocardial infarction (PMI) (type 5 MI) after OPCABG. Results MGF-LAD,(26 vs 50) MGF-LCX (24 vs 43) and MGF-RCA (24 vs 39) were significantly higher in patients who did not experience PMI than in those who experienced PMI. The PI-LCX (2.4 vs 2.0) is opposite. MGF-LAD, MGF-LCX, MGF-RCA and PI-LCX were significant predictors of PMI.(Table 1.) When the LIMA-LAD flow rate is greater than 26.5 and the PI is less than 1.75, it is a protective factor for perioperative myocardial infarction. Transplant flow rates with LCX greater than 38 ml/min and PI less than 3.45 may have a protective effect on perioperative posterior wall myocardial infarction. Right coronary artery blood flow velocity greater than 26.5 ml/min has a significant protective effect on posterior wall myocardial infarction. For patients with diffuse lesions of the right coronary artery, SCVBG has better transplant blood flow than CE (43 vs 25.5) and lower PI (1.3 vs 1.85), which can reduce the risk of perioperative arrhythmia and posterior wall myocardial infarction in OPCABG. Conclusions This prospective cohort study suggests that TTFM measurement has predictive value for the occurrence of perioperative myocardial infarction in OPCABG. Among them, LIMA-LAD graft flow greater than 28.5ml/min and PI less than 1.75 are protective factors for perioperative anterior wall myocardial infarction, while sequential bridge LCX graft flow greater than 38ml/min, RCA flow greater than 26.5ml/min, and PI less than 3.45 are protective factors for perioperative lateral posterior wall myocardial infarction.In addition, based on the above results, this study analyzed the surgical procedures of patients with extremely poor vascular conditions in the right coronary artery. The study showed that SCVBG is significantly safer than CE.

Purinergic receptor P2X7 has been considered as a potential new target for detecting and treating high-risk plaque. Nanobodies are the smallest antibody fragments with high antigen binding ability and specificity, which are well-suited for radionuclide imaging. The present study aimed to develop a novel P2X7-targeted nanobody SPECT tracer and to investigate its potential for identification of atherosclerotic plaque (AP). The anti-P2X7 nanobody 1c81 was site-specifically conjugated with [99mTc]Tc-HYNIC-GGGC via sortase A-mediated transpeptidation to prepare [99mTc]Tc-1c81. Saturation binding experiments and cell-binding assays were performed to evaluate their affinity and specificity. Biodistribution studies in C57 mice were conducted at 0.5, 1, and 2 h postinjection (p.i.), and SPECT/CT imaging was performed in ApoE-/- (high-fat diet) and C57 mice (normal diet) at 2 h p.i, respectively. Specific binding was validated by blocking studies (coinjection of [99mTc]Tc-1c81 with excess unlabeled 1c81) in ApoE-/- mice. Target-to-background ratio (TBR) was calculated for AP at aortic arch. The harvested aortas were analyzed by autoradiography, Oil Red O lipid staining, and immunofluorescence staining (CD68, P2X7) to correlate tracer uptake with AP characteristics. To further validate the clinical relevance, human coronary endarterectomy (CE) specimens were analyzed for P2X7 and CD68 expression using immunohistochemistry. [99mTc]Tc-1c81 was synthesized with 53.77 ± 0.06% radiochemical yield, > 95% purity, 11.13 ± 2.78 MBq/nmol molar activity, and a binding dissociation constant of 6.38 nM. Biodistribution showed rapid clearance from the blood and normal organs except the kidneys. SPECT imaging at 2 h p.i. revealed clear aortic arch visualization, with significantly higher TBR in ApoE-/- mice compared to both C57 and blocking groups (4.49 ± 1.88 vs 0.96 ± 0.64, P = 0.012; 4.49 ± 1.88 vs 1.40 ± 0.28, P = 0.017). Autoradiography further confirmed specific tracer accumulation in APs, colocalizing with Oil Red O-positive lipid-rich regions. Immunofluorescence and immunohistochemical staining validated high P2X7 receptor expression in both mouse AP aortic valve sections and human CE specimens, which was colocalized with CD68+ inflammatory cells, confirming the clinical relevance of P2X7 as an imaging target for inflammation of AP. [99mTc]Tc-1c81 exhibited specific binding to the P2X7 receptor in AP in vivo. It may serve as a novel P2X7-targeted SPECT tracer to detect AP, with promising applications in clinical risk stratification and treatment response monitoring.

BACKGROUND:The aims of this study were to evaluate σ2R (sigma-2 receptor)/TMEM97 (transmembrane protein 97) expression in atherosclerotic plaques, and assess the feasibility of in vivo atherosclerotic plaques imaging using the σ2R/TMEM97 targeting probe 1-(4-(5,6-dimethoxyisoindolin-2-yl)butyl)-3-(2-[18F]fluoroethyl)-1,3-dihydro-2H-benzo[d]imidazol-2-one ([18F]SYB-NF) developed in our laboratory. METHODS:Hematoxylin and eosin and immunohistochemical staining were performed on both human coronary endarterectomy specimens and mouse samples. The expression of σ2R/TMEM97 in RAW 264.7 cells incubated with ox-LDL (oxidized low-density lipoprotein) was analyzed using western blot analysis. Positron emission tomography imaging with [18F]SYB-NF, [18F]NaF, and 2-[18F]fluoro-2-deoxy-d-glucose was conducted in wide-type C57BL/6 and ApoE-/- mice. Specific binding was evaluated by coinjecting [18F]SYB-NF with the σ2R/TMEM97 antagonist CM398 ([1-(4-(6,7-dimethoxy-3,4-dihydroisoquinolin-2(1H)-yl)butyl)-3-methyl-1H-benzo[d]imidazol-2(3H)-one]). Autoradiography and Oil Red O staining were performed on harvested aortas and corresponding sections. RESULTS:Staining results demonstrated significant upregulatiaon of σ2R/TMEM97 expression at the early plaque formation and throughout the atherosclerosis progression. Western blot analysis indicated that incubation of macrophages with ox-LDL led to increased σ2R/TMEM97 expression. [18F]SYB-NF specifically accumulated in the aortic arch of ApoE-/- mice. Treatment with CM398 significantly reduced the standardized uptake value in the aortic arch of ApoE-/- mice. [18F]SYB-NF exhibited a higher standardized uptake value in the aortic arch (0.67±0.09 versus 0.51±0.07) and higher aortic arch-to-heart ratio (2.58 versus 0.56) in ApoE-/- mice compared with 2-[18F]fluoro-2-deoxy-d-glucose, and a higher aortic arch-to-bone ratio (2.24 versus 0.44) compared with [18F]NaF. Autoradiography analysis revealed a strong correlation between the positive area in Oil Red O staining and autoradiography (Pearson correlation coefficient=0.993; P=0.001), further supporting the association between elevated σ2R/TMEM97 expression and plaque formation. CONCLUSIONS:σ2R/TMEM97 may serve as a potential biomarker for atherosclerotic plaques, and σ2R/TMEM97 positron emission tomography imaging may be used to monitor plaque formation and progression, as well as the efficacy of emerging therapeutic strategies for atherosclerotic plaques.

The value of preoperative multidisciplinary approach remains inadequately delineated in forecasting postoperative outcomes of patients undergoing coronary artery bypass grafting (CABG). Herein, we aimed to ascertain the efficacy of multi-modality cardiac imaging in predicting post-CABG cardiovascular outcomes. Patients with triple coronary artery disease underwent cardiac sodium [18F]fluoride ([18F]NaF) positron emission tomography/computed tomography (PET/CT), coronary angiography, and CT-based coronary artery calcium scoring before CABG. The maximum coronary [18F]NaF activity (target-to-blood ratio [TBR]max) and the global coronary [18F]NaF activity (TBRglobal) was determined. The primary endpoint was perioperative myocardial infarction (PMI) within 7-day post-CABG. Secondary endpoint included major adverse cardiac and cerebrovascular events (MACCEs) and recurrent angina. This prospective observational study examined 101 patients for a median of 40 months (interquartile range: 19–47 months). Both TBRmax (odds ratio [OR] = 1.445; p = 0.011) and TBRglobal (OR = 1.797; P = 0.018) were significant predictors of PMI. TBRmax>3.0 (area under the curve [AUC], 0.65; sensitivity, 75.0 www.chictr.org.cn/showproj.html?proj=37933 ).

Background For complete revascularization, patients with diffuse coronary artery disease should have a coronary endarterectomy and a coronary artery bypass graft (CE-CABG). Sadly, CE can lead to a lack of endothelium, which raises the risk of thrombotic events. Even though daily dual antiplatelet therapies (DAPT) have been shown to reduce thrombotic events, the risk of perioperative thrombotic events is high during the high-risk period after CE-CABG, and there is no consistent protocol to bridge DAPT. This trial aims to compare safety and efficacy between tirofiban and heparin as DAPT bridging strategies after CE-CABG. Methods In phase I, 266 patients undergoing CE-CABG will be randomly assigned to tirofiban and heparin treatment groups to compare the two treatments in terms of the primary safety endpoint, chest tube drainage in the first 24 h. If the phase I trial shows tirofiban non-inferiority, phase II will commence, in which an additional 464 patients will be randomly assigned. All 730 patients will be studied to compare major cardiovascular and cerebrovascular events (MACCEs) between the groups in the first 30 days after surgery. Discussion Given the possible benefits of tirofiban administration after CE-CABG, this trial has the potential to advance the field of adult coronary heart surgery. Trial registration chictr.org.cn, ChiCTR2200055697. Registered 6 January 2022. https://www.chictr.org.cn/com/25/showproj.aspx?proj=149451 . Current version: 20,220,620.

Objective To verify the administration of a new nano delivery system coated with Tirofiban on preventing early thrombosis in vein graft. Methods Forty New Zealand white rabbits were randomly divided into five groups with eight rabbits in each group. The rabbits of all groups underwent jugular vein transplantation, except group I with only neck opening and closing operation. Vein grafts of group II were preprocessed by intravenous injection of normal saline; group III were preprocessed by tirofiban alone; group IV were preprocessed by unloaded nanoparticles of PLGA-PEG; group V were preprocessed by PLGA-PEG coated with tirofiban. Coagulation and platelet function of peripheral and vein graft blood were detected at 1, 2, 4, 12 h and 1, 3, 7, 10, 14 days after operation. Patency rate of vein graft and blood flow index were measured by vascular ultrasound at third, seventh, 10th, and 14th days after operation; two rabbits in each group were randomly sacrificed at the corresponding time of detection. Pathological differences of vein grafts were observed by HE stainin. Results The patency rate of vein grafts in group V was significantly higher than that in group II to IV. The platelet and platelet aggregation rate in group V were inhibited in vein graft blood significantly. The post-operative PT and APTT in vein graft blood in group V were increased obviously while the FBG, D-dimer and FDP were significantly inhibited. Except group I, the lumen loss rate of vein grafts in group V was significantly lower than that in other groups, and vein graft blood in group V had a significant lower expression of platelet P-selectin and GP IIb/IIIa receptor than that in other groups. Conclusion This study proves that PEG-PLGA coated with tirofiban can effectively prevent early vein graft stenosis from thrombosis by inhibition of platelet function, coagulation function.

Depression is a significant factor contributing to postoperative occurrences, and patients diagnosed with depression have a higher risk for postoperative complications. Studies on cardiovascular surgery extensively addresses this concern. Several studies report that people who undergo coronary artery bypass graft surgery have a 20% chance of developing postoperative depression. A retrospective analysis of medical records spanning 21 years, involving 817 patients, revealed that approximately 40% of individuals undergoing coronary artery bypass grafting (CABG) were at risk of perioperative depression. Patients endure prolonged suffering from illness because each attempt with standard antidepressants requires several weeks to be effective. In addition, multi-drug combination adjuvants or combination medication therapy may alleviate symptoms for some individuals, but they also increase the risk of side effects. Conventional antidepressants primarily modulate the monoamine system, whereas different therapies target the serotonin, norepinephrine, and dopamine systems. Esketamine is a fast-acting antidepressant with high efficacy. Esketamine is the S-enantiomer of ketamine, a derivative of phencyclidine developed in 1956. Esketamine exerts its effect by targeting the glutaminergic system the glutaminergic system. In this paper, we discuss the current depression treatment strategies with a focus on the pharmacology and mechanism of action of esketamine. In addition, studies reporting use of esketamine to treat perioperative depressive symptoms are reviwed, and the potential future applications of the drug are presented.

BACKGROUND 18F-sodium fluoride (18F-NaF) positron emission tomography (PET)/computed tomography (CT) is a promising new approach for assessing microcalcification in vascular plaque. OBJECTIVES This prospective study aimed to evaluate the associations between in vivo coronary 18F-NaF PET/CT activity and ex vivo histological characteristics, to determine whether coronary 18F-NaF activity is a novel biomarker of plaque pathological vulnerability, and to explore the underlying physiological environment of 18F-NaF adsorption to vascular microcalcification.METHODS Patients with coronary artery disease (CAD) underwent coronary computed tomography angiography (CTA) and 18F-NaF PET/CT. Histological vulnerability and immunohistochemical characteristics were evaluated in coronary endarterectomy (CE) specimens from patients who underwent coronary artery bypass grafting with adjunctive CE. Correlations between in-vivo coronary 18F-NaF activity with coronary CTA adverse plaque features and with ex vivo CE specimen morphological features, CD68 expression, inflammatory cytokines expression (tumor necrosis factor -a, interleukin-1b), osteogenic differentiation cytokines expression (osteopontin, runt-related transcription factor 2, osteocalcin) were evaluated. High-and low-to medium-risk plaques were defined by standard pathological classification.RESULTS A total of 55 specimens were obtained from 42 CAD patients. Coronary 18F-NaF activity of high-risk specimens was significantly higher than low-to medium-risk specimens (median [25th-75th percentile]: 1.88 [1.41-2.54] vs 1.12 [0.91-1.54]; P < 0.001). Coronary 18F-NaF activity showed high discriminatory accuracy in identifying high-risk plaque (AUC: 0.80). Coronary CTA adverse plaque features (positive remodeling, low-attenuation plaque, remodeling index), histolog-ically vulnerable features (large necrotic core, thin-fibro cap, microcalcification), CD68 expression, tumor necrosis factor -a expression, and interleukin-1b expression correlated with coronary18F-NaF activity (all P < 0.05). No significant association between coronary 18F-NaF activity and osteogenic differentiation cytokines was found (all P > 0.05).CONCLUSIONS Coronary 18F-NaF activity was associated with histological vulnerability, CD68 expression, inflamma-tory cytokines expression, but not with osteogenic differentiation cytokines expression. 18F-NaF PET/CT imaging may provide a powerful tool for detecting high-risk coronary plaque and could improve the risk stratification of CAD patients. (J Am Coll Cardiol Img 2023;16:508-520) (c) 2023 by the American College of Cardiology Foundation.

Objective:To explore the clinical value of aspirin combined with atorvastatin in the prevention of new onset atrial fibrillation after off-pump coronary artery bypass grafting (OPCABG).Methods:208 patients with coronary artery bypass grafting in our hospital from June 2019 to June 2021 were selected as the research subjects and divided by a random number table method into groups. The control group (104 cases) was treated with aspirin before operation, and the observation group (104 cases) was treated with aspirin and atorvastatin before operation. ECG monitoring was carried out continuously for 7 days of patients in the two groups, and the occurrence and duration of AF were recorded. The clinical therapeutic efficacy, incidence and adverse reactions of AF, left atrial diameter and high-sensitivity C-reactive protein (hs-CRP) level were observed before and after treatment.Results:The incidence of AF in the observation group was significantly lower than that in the control group, the difference was statistically significant ( P<0.05). There was no statistical significant difference in the starting time of AF between the two groups after operation ( P>0.05). The duration of AF in the observation group was better than that in the control group, the difference was statistically significant ( P<0.05). Before treatment, there was no statistical significant difference in left atrial diameter and hs-CRP level between the two groups ( P>0.05). After treatment, the left atrial diameter in the observation group returned to that before treatment, and there was no statistical significant difference in the same group ( P>0.05). The left atrial diameter in the control group was higher than that before treatment, and there was statistical significant difference in the same group ( P<0.05). The level of hs-CRP was lower than that in the control group, the difference was statistically significant ( P<0.05). There were no adverse reactions in both groups. Conclusion:Aspirin combined with atorvastatin has a significant effect in preventing new onset AF after OPCABG. It can reduce the incidence of postoperative AF, shorten the duration of AF, effectively control the inner diameter of left atrium, reduce the degree of postoperative inflammatory reaction, and has no adverse effects. It is worthy of clinical application.

Background and aims:The risk factors of perioperative and long-term cardiovascular events in patients undergoing coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) are not well determined. This study evaluated the clinical value of coronary plaque burden, coronary anatomic stenosis, and serum biomarkers for predicting perioperative cardiovascular events after off-pump CABG + CE.Methods:This retrospective cohort single-center study enrolled 125 patients undergoing off-pump CABG + CE between February 2018 and September 2021 in China. Coronary plaque burden was reflected by the length of plaque removed by CE. Plaque length-max, which represents the plaque length in patients undergoing single-vessel CE and the maximum plaque length in patients undergoing multivessel CE, was calculated. The primary endpoint was perioperative myocardial infraction (PMI).Results:Plaque length-max was significantly higher in patients with PMI than in those without PMI (2.4 ± 1.5 vs. 1.6 ± 0.9, p = .001). A threshold plaque length-max of 1.15 cm was an independent predictor of PMI (area under the curve: 0.67; sensitivity 87.9%; specificity 59.8%; p = .005). Patients with plaque length-max ≥1.15 had a > 5-fold increase in PMI after adjusting for confounding factors (odds ratio = 5.89; p = .002). Furthermore, interleukin-6 (Beta = .32: p = .028), CD68 (Beta = .34; p = .045), and osteopontin (Beta = .43; p = .008) were significantly correlated with plaque length-max.Conclusions:Plaque length-max was superior to clinical cardiovascular risk factors in predicting PMI occurrence after off-pump CABG + CE, which might be associated with systemic and plaque inflammation state.

Background: We visually assessed the research hotspots of familial hypercholesterolemia (FH) using bibliometrics and knowledge mapping in light of the research state and development trend of FH. Methods: We employed bibliometric tools, such as CiteSpace and the alluvial generator, to illustrate the scientific accomplishments on FH by extracting pertinent literature on FH from the Web of Science Core Collection database from January 1, 2002, to December 31, 2022. Results: A total of 4402 papers in total were selected for study; 29.2% of all articles globally were from the USA, followed by the Netherlands and England. The University of Amsterdam, University of Oslo, and University of Western Australia are the 3 institutions with the most publications in this area. Gerald F. Watts, Raul D. Santos, and John J. P. Kastelein wrote the majority of the pieces that were published. The New England Journal of Medicine, Circulation, and Atherosclerosis were the journals with the greatest number of papers in this field. Prevalence and genetic analysis of FH, proprotein convertase subtilisin/kexin 9 inhibitors, and inclisiran are current research hotspots for the condition. Future research in this area will be focused on gene therapy. Conclusions: FH research has shown shows a trend of ascending followed by leveling off. The prevalence and diagnosis of FH, proprotein convertase subtilisin/kexin 9 inhibitors, inclisiran, and gene therapy are current research hotspots. This report may serve as a reference for current research trends.

Introduction Although the vast majority of patients with a myocardial bridge (MB) are asymptomatic, the anomaly was found to be associated with stable or unstable angina, vasospastic angina, acute coronary syndrome, and even malignant arrhythmias and sudden cardiac death in some cases. Methods By retrieving the relevant literature on MB from 1 January 1980 to 31 July 2022 from the Web of Science Core Collection (WoSCC) database, we used the bibliometric tools, including CiteSpace, VOS viewer, and alluvial generator, to visualize the scientific achievements on MB. Results A total of 630 articles were included. The number of published articles was in a fluctuating growth trend. These publications came from 37 contries, led by the USA and China. The leading country on MB was the United States, the leading position among institutions was Stanford University, and the most productive researcher on MB was Jennifer A. Tremmel. After analysis, the most common keywords were myocardial bridge, mortality, coronary angiography, descending coronary artery, and sudden death. Conclusion Our findings can aid researchers in understanding the current state of MB research and in choosing fresh lines of inquiry for forthcoming investigations. Prevalence and prognosis, mechanism atherosclerosis, hemodynamic significance, and molecular autops will likely become the focus of future research. In addition, more studies and cooperations are still needed worldwide.

Background: The benefits of selective coronary vein bypass grafting (SCVBG) for patients with severe diffuse lesions of the right coronary artery (RCA) who are unsuitable for coronary endarterectomy (CE) are unclear. Methods: We recruited patients with diffuse lesions of the RCA undergoing coronary artery bypass surgery between January 2015 and December 2018 and matched SCVBG and CE patients on propensity score (PS). We evaluated the degree of single-stenosis in the RCA, incidence of perioperative myocardial infarction (MI) and major adverse cardiovascular and cerebrovascular events (MACCE), influencing factors of perioperative MACCE, long-term survival rate, and long-term MACCE incidence. Results: Overall, 430 patients were enrolled: 344 (80%) underwent CE and 86 (20%) underwent SCVBG [n=78 and n=64, respectively, after PS matching]. The incidence of perioperative MI and MACCE were significantly lower in the SCVBG group (5.1% vs. 1.5%, P<0.05; and 10.2% vs. 4.7%, P<0.05). When the vascular flow rate of the graft anastomosed to RCA in the SCVBG group was above 100 mL/min, the incidence of perioperative MACCE significantly increased [odds ratio (OR): 1.94, 95% confidence interval (CI): 1.42-2.03]. Choosing the bilateral internal mammary artery for SCVBG reduced the incidence of perioperative MACCE (OR: 0.82, 95% CI: 0.68-0.92). There was no significant difference in the rates of long-term survival or MACCE between the two groups before or after PS matching (P>0.05). Conclusions: SCVBG is an acceptable surgical intervention for patients with severe diffuse RCA lesions.

Background: Data on the relationship between the triglyceride glucose (TyG) index and prognosis after off-pump coronary artery bypass grafting (OPCABG) are limited. This retrospective observational study evaluated the association of the TyG index with prognosis in patients with type 2 diabetes mellitus (T2DM) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent OPCABG. Methods: A total of 1534 patients with T2DM who underwent OPCABG for NSTE-ACS were enrolled in this study. Patients were divided into lower and higher TyG index groups according to the optimal cutoff value of the TyG index for predicting the primary endpoint. The primary outcomes included the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which were defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke and symptomatic graft stenosis or occlusion. The TyG index was calculated using the following equation: TyG index = ln (fasting triglyceride level [mg/dL] × fasting glucose level [mg/dL]/2). Results: The overall incidence of MACCEs was 10.7% with a median follow-up of 23.1 months. The optimal TyG index cutoff for predicting MACCEs was 9.42 (sensitivity 49.4%; specificity 71.2%; area under the curve 0.631; P < 0.001). The incidence of MACCEs increased with a 1-unit increase in the TyG index [HR 2.218, 95% CI (1.733-2.839), P < 0.001]. A TyG index greater than 9.42 was independently associated with a higher risk of MACCEs [HR 2.092, 95% CI (1.573-2.784), P < 0.001] and each component. Furthermore, the effect of TyG in increasing MACCEs was consistent across groups of age, sex, BMI, hypertension, LDL-C, oral hypoglycemic agents, LIMA, number of grafts and IABP groups, except in patients diagnosed with NSTEMI, treated with statins and prescribed insulin at discharge. Conclusion: The TyG index predicts future MACCEs independently of known cardiovascular risk factors, suggesting that the TyG index may be a useful marker for prognosis in patients with T2DM and NSTE-ACS who underwent OPCABG.

To investigate the prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and analyze the effects of OSAHS on the incidence of post-OPCABG complications, length of stay in intensive care unit (ICU) and hospitalization, and hospital expense. This prospective study included patients undergoing OPCABG at Beijing An Zhen hospital from January 2018 to December 2018. OSAHS was diagnosed by using a portable sleep monitor before surgery. Among 74 patients, the prevalence of OSAHS and moderate to severe OSAHS (apnea hypopnea index (AHI) ≥ 15) was 70

18F-NaF PET/CT is a novel approach to detect and quantify microcalcification in atherosclerosis. We aimed to explore the underlying systematic vascular osteogenesis in the coronary artery and aorta in patients with multivessel coronary artery disease (CAD). Patients with multivessel CAD prospectively underwent 18F-NaF PET/CT. The coronary microcalcification activity (CMA) and aortic microcalcification activity (AMA) were calculated based on both the volume and intensity of 18F-NaF PET activity. Peri-coronary adipose tissue (PCAT) density was measured in adipose tissue surrounding the coronary arteries and the 18F-NaF tissue-to-blood ratio (TBR) was measured in the coronary arteries. 100 patients with multivessel CAD were prospectively recruited. The CMA was significantly associated with the AMA (r = 0.70; P < .001). After multivariable adjustment, the CMA was associated with the AMA (Beta = 0.445 per SD increase; P < .001). The coronary TBR was also significantly associated with the PCAT density (r = 0.56; P < .001). The PCAT density was independently associated with the coronary TBR after adjusting confounding factors. Coronary 18F-NaF uptake was significantly associated with the PCAT density. There was a significant relationship between the coronary and the aortic 18F-NaF uptake. It might indicate an underlying systematic vascular osteogenesis in patients with multivessel CAD.

冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是治疗冠状动脉左主干和3支病变的有效手段,实现完全冠状动脉血运重建是手术的优势和关键所在[1].而围术期心肌梗死(perioperative myocardial infraction,PMI)不仅增加了围术期死亡风险和并发症的发生,同时也增加了中远期不良心脑血管事件和桥血管再狭窄的发生[2-3].尽管CABG手术方式日趋成熟和标准化,但PMI的发生率高达5％～30％[4],对于日益增多的弥漫性冠状动脉病变患者,PMI的发病率及病死率更高[5],且患者中远期预后也不理想[6].因此,有效降低PMI的发生重在预防.本文对近年来关于CABG术后围术期心肌梗死的发生机制及预测手段作简要综述.

Background This study sought to compare and evaluate the clinical efficacy and safety of Y-type coronary artery bypass grafting (CABG) and sequential CABG. However, the prognosis and complication rate of the two treatments are different. Therefore, we need to systematically compare the efficacy and safety of the two surgical schemes. Methods A total of 112 patients who underwent Y-type CABG and 113 patients who underwent sequential CABG were selected from January 2020 to December 2020. The patients undergoing Y-type CABG of the great saphenous vein (SV) were classified as the experimental group, and those undergoing sequential anastomosis were classified as the control group. The intraoperative blood flow at each anastomotic site of the venous sequential CABG, left ventricular ejection fraction (LVEF), and left ventricular diastolic diameter (LVEDD) at the end of 3 months, 6 months, and 1 year after surgery, the incidence rate of major adverse cardiovascular events, and coronary angiography (CAG) after readmissions due to similar symptoms were compared between the 2 groups. The bridging vascular blockage rate was also determined. Results There was no significant difference in cardiac function between the 2 groups in the short term, and the incidence of major adverse cardiovascular events in the 2 groups mainly occurred in the middle-postoperative period (1 year after surgery) or later. There was no statistical difference in the intraoperative real-time blood flow measurements at each anastomosis of the venous bridge between the 2 groups. Compared to the control group, the LVEF of the experimental group was significantly increased at the 1-year follow-up point (51.6±5.1 vs. 67.6±5.6, P=0.001). During the operation of Y-type coronary artery bypass grafting, the incidence of major adverse cardiovascular events, vascular bridge, and anastomotic blockage were significantly decreased (16 vs. 39, P=0.023). Conclusions Large SV Y-type CABG can improve postoperative left heart function and reduce the incidence of postoperative adverse events, which may be of great significance for improving the postoperative mid-term survival rate of patients.