Image(s) Emergency coronary angiography and computed tomography angiography showing catheterization laboratory (Cath-Lab) clues to type A aortic dissection presenting as acute myocardial infarction. Case Summary A 67-year-old man underwent emergency angiography for anterior ST-segment elevation. Difficult coronary engagement, thin strip-like left coronary narrowing, and marked catheter swing prompted reassessment. Computed tomography angiography confirmed type A aortic dissection involving the left main ostium, and unnecessary percutaneous coronary intervention was avoided. Five recurring angiographic warning clues are summarized. Take-Home Messages These 5 practical Cath-Lab clues would help you away from emergency type A aortic dissection trap. Timely recognition of Cath-Lab clues and pause; activate the aortic surgical team.

Objective: To explore the risk factors for bird-beak configuration occurrence and its outcomes after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD). Methods: A total of 701 patients with TBAD diagnosed by thoracic aortic computed tomography angiography and treated using TEVAR from January 2010 to December 2022 were retrospectively enrolled. According to the occurrence of a bird-beak configuration in the proximal end of the stent-graft, the patients were divided into a bird-beak group (n = 291) and a non-bird-beak group (n = 410). The baseline and perioperative data, the incidence of clinical adverse events during follow-up were compared between the 2 groups. Multivariate logistic regression was performed to analyze the risk factors and prognosis associated with the formation of the bird-beak configuration. A sub-analysis was further undertaken within the bird-beak group based on the presence (n = 84) or absence (n = 207) of an immediate intraoperative endoleak. The Kaplan-Meier method was used to analyze the incidence of events in the bird-beak subgroup. Results: Baseline analysis showed that compared with the non-bird-beak group, the bird-beak group comprised significantly more men, and was associated with a higher frequency of calcium channel blocker use, but a lower proportion of stroke history (all P < 0.05). The perioperative data demonstrated that the bird-beak group received longer stents, had a higher percentage of proximal landings in aortic Zone 2, and exhibited a greater proportion of immediate intraoperative endoleaks (all P < 0.05). The distal stent diameter and the proportion of proximal bare stents were both significantly smaller in the bird-beak group than in the non-bird-beak group (P < 0.05). Multivariate logistic regression suggested that proximal landing in aortic Zone 2 (odds ratio (OR) = 1.839, 95% confidence interval (CI): 1.133-2.985; P = 0.014) and stent length (OR = 1.013, 95% CI: 1.002-1.025; P = 0.021) were independent risk factors for the formation of the bird-beak configuration, whereas the use of proximal bare stents (OR = 0.019, 95% CI: 0.010-0.039; P < 0.001) was an independent protective factor. Short- and long-term follow-up revealed no significant differences in the incidence of aortic-related or overall clinical adverse events between the 2 groups (all P > 0.05). In the subgroup analysis, the incidence of distal stent-graft-induced new entry, new endoleak, aortic-related adverse events, and overall clinical adverse events was higher in the immediate intraoperative endoleak group than in the non-immediate intraoperative endoleak group (all P < 0.05). Kaplan-Meier analysis further demonstrated that the immediate intraoperative endoleak group displayed a significantly higher incidence (Plog-rank = 0.005) of aorta-related adverse events and a greater overall incidence of clinical adverse events than the non-immediate intraoperative endoleak group ( Plog-rank = 0.031). Conclusion: During TEVAR for TBAD, proximal landing in aortic Zone 2 and stent length are independent risk factors for bird-beak configuration formation, whereas proximal bare stent use serves as a protective factor. While the bird-beak configuration is associated with the occurrence of immediate intraoperative endoleak during TEVAR, it does not exert a significant adverse effect on the prognosis of patients with TBAD. However, the bird-beak configuration combined with an immediate intraoperative endoleak is associated with worse outcomes.

Objective:To investigate the joint effect of free fatty acid (FFA) and the triglyceride-glucose (TyG) index on the prognosis of overweight and obese coronary artery disease (CAD) patients. Methods:A total of 5,887 patients were enrolled in this study. Restricted cubic spline analyses were used to assess the dose-response relationship of FFA and TyG with major adverse cardiovascular and cerebrovascular events (MACCE). Mediation analysis was used to examine whether TyG mediated the association between FFA and MACCE. Kaplan-Meier survival curves were used to compare the cumulative incidence of events. Multivariable Cox models were used to explore the independent association between Low-/High-FFA and Low-/High-TyG on outcomes. Results:FFA and TyG were independent predictors of MACCE. TyG mediated 10.7% of the association between FFA and MACCE. Patients with high FFA and TyG levels exhibited a markedly higher MACCE risk (adjusted hazard ratio: 1.951, 95% confidence interval: 1.533-2.484; P < 0.001), with a significant interaction between FFA and TyG. Among patients with elevated FFA levels, MACCE increased progressively across higher TyG tertiles ( P for trend = 0.001). Conclusions:FFA and the TyG index independently predict adverse outcomes in overweight or obese CAD patients, with the TyG index mediating the relationship between FFA and MACCE. Their combined assessment enhances the risk stratification in this population.

ObjectiveThe aim of this study was to investigate the 12—month clinical outcomes and 6—month morphological changes of acute penetrating aortic ulcers (PAUs) after thoracic endovascular aortic repair (TEVAR) combined with antiplatelet (AP) drugs.MethodsPatients who underwent TEVAR for acute PAUs at the General Hospital of Northern Theater Command from January 2012 to June 2024 were included. Demographics, clinical data, and imaging characteristics were retrospectively collected. The primary outcome was major adverse events, defined as a composite of death, endoleak, aortic rupture or re-dissection, re-intervention, stroke, acute myocardial infarction, and hemorrhage (BARC ≥ 2 grade).ResultsOf the 195 patients, 59 were treated with AP drugs (AP group) and 136 without AP drugs (NAP group). There were no significant differences in preoperative demographic or imaging characteristics between the two groups. A total of 180 patients with acute PAUs underwent CTA reexamination within 6 months after TEVAR. At 6-month follow-up, the mean imaging parameters were as follows: aortic diameter at PAU, 32.44 ± 2.19 mm; PAU diameter, 1.83 ± 1.77 mm; PAU depth, 1.46 ± 0.96 mm; and intramural hematoma (IMH) thickness, 1.16 ± 1.03 mm. There were no significant differences in these aforementioned parameters between the AP and NAP groups. Compared with preoperative imaging parameters, neither group showed a significant difference in aortic diameter at PAUs; however, PAU diameter and depth were smaller in both the AP and NAP groups (all P < 0.001), and IMH thickness was also smaller in both groups (all P < 0.001). During 12-month follow-up, 31 patients (15.8%) experienced a primary outcome event. The cumulative incidence of major adverse events at 30 days and 12 months was higher in the AP group than in the NAP group (5.1% vs. 4.4% at 30 days; 18.6% vs. 14.7% at 12 months), but there were no statistically significant differences between the two groups. Cox regression analysis showed that maximum aortic diameter, PAU diameter ≥ 10.5 mm, and PAU depth ≥ 7.5 mm were associated with major adverse events.ConclusionThe present study indicated that AP therapy may be safe for patients with acute PAUs who underwent TEVAR. Maximum aortic diameter, PAU diameter ≥ 10.5 mm, and PAU depth ≥ 7.5 mm were associated with major adverse events.

Objective To investigate the effect of anti-thrombotic (AT) drugs on aortic remodeling and clinical prognosis after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD). Methods This retrospective observational study included consecutive patients with acute TBAD who underwent TEVAR and underwent computed tomography angiography (CTA) preoperatively and during follow-up between January 2012 and September 2023 at the General Hospital of Northern Theater Command. Based on whether AT therapy was administered, the patients were divided into the AT group (patients receiving AT drugs) and the NAT group (patients not receiving AT drugs). Image data were analyzed for the thrombosis status of the false lumen (FL), as well as changes in the maximum diameter of the true lumen (TL), FL, and transaortic lumen (TAL) in the stented thoracic aorta (STA), unstented thoracic aorta (UTA), and abdominal aorta (AA). 12 - month clinical outcomes (major adverse event) were also recorded. Results A total of 175 patients with acute TBAD were included in this study. The preoperative FL status of patent, partial thrombosis, and complete thrombosis, respectively, in the STA, UTA, and AA showed no significant differences between the AT and NAT groups. The preoperative mean inner diameters of TL, FL, and TAL, respectively, in the STA, UTA, and AA were also not significantly different between the two groups. Similar to the aforementioned in the preoperative, there were also no significant differences between the two groups at the 12-month follow-up. At 12-month follow-up, FL status (patent vs. completely thrombosed) showed significantly favorable changes compared with preoperative images in the STA, UTA, and AA segments (all P < 0.001). In both the AT and NAT groups, changes in the maximum diameter of TL, FL, and TAL in all segments were statistically significant at 12-month follow-up (all P < 0.001). Regarding diameter changes: TAL expansion was 4.0%, 14.9%, and 53.7% in the STA, UTA, and AA, respectively; TAL stabilization was 62.3%, 36.6%, and 44.6% in the STA, UTA, and AA, respectively; and TAL shrinkage was 33.7%, 48.6%, and 1.7% in the STA, UTA, and AA, respectively. During a 12-month follow-up, 13 patients (7.4%) had a major adverse event. Moreover, the difference between the two groups was not statistically significant (P > 0.05). Conclusions Among acute TBAD patients who underwent TEVAR, at the 12 - month follow-up, patients receiving AT drugs had a comparable prognosis in aortic remodeling to those not receiving AT drugs.

The mechanical reliability of self-expanding stents critically depends on the ability of their constituent beam elements to sustain large bending deformation without instability. While NiTi alloys are widely used, their processing complexity and transformation-related uncertainties motivate the exploration of alternative metallic systems. Zr-based metallic glasses (MGs), which combine high elastic recoverability with structural homogeneity, offer a compelling but insufficiently understood option under bending-dominated loading. In this study, the bending deformation behavior of a 0.25 mm-thick Zr61Ti2Cu25Al12 (ZT1) high-toughness MG beam is investigated under conditions relevant to miniaturized stent architectures. Emphasis is placed on precisely capturing the onset of yielding under bending, unraveling the two-stage evolution and underlying mechanisms of shear-band-mediated plasticity, and clarifying the size-dependent nature of plastic deformation stability in MG beams. The results reveal a distinct bending-specific deformation response that differs fundamentally from uniaxial loading, characterized by thickness-sensitive shear-band organization and enhanced resistance to shear localization. By linking these observations to fracture-mechanics considerations, this study provides a mechanistic framework for understanding why thin MG beams can accommodate large bending strains without catastrophic failure. The insights gained establish a foundation for the rational design of MG components in bending-dominated biomedical devices.

BACKGROUND:The safety and efficacy of aspirin combined with ticagrelor or clopidogrel remain unclear in ST-segment elevation myocardial infarction (STEMI) patients with Diabetes mellitus (DM) and poor glycemic control. AIMS:This study aims to assess the efficacy and safety of ticagrelor versus clopidogrel-based dual antiplatelet therapy in STEMI patients with DM and poor glycemic control undergoing pPCI. METHODS:We evaluated 2732 STEMI patients with DM and poor glycemic control who underwent primary percutaneous coronary intervention (pPCI) and were registered in the "Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS)" program between November 2014 and December 2019. Using propensity score matching (PSM) and cox proportional hazards regression, we compared the in-hospital risk of major adverse cardiovascular events (MACCE), TIMI bleeding events, and net adverse clinical events (NACE) between patients receiving aspirin combined with either ticagrelor or clopidogrel. RESULTS:After PSM, the risk of in-hospital MACCE (HR = 0.545, 95% CI: 0.321-0.926, p = 0.025), Cardiac death (HR = 0.380, 95% CI: 0.149-0.971, p = 0.043) and NACE (HR = 0.728, 95% CI: 0.560-0.947, p = 0.018) was significantly lower in the ticagrelor group compared with the clopidogrel group (p < 0.05), while no significant difference was observed in the incidence of TIMI-bleeding events between the two groups (p > 0.05). CONCLUSION:Among STEMI patients with DM and poor glycemic control undergoing pPCI, ticagrelor use was associated with a low rate of MACCE, without an excessive risk of bleeding. TRIAL REGISTRATION:The information of clinical trial registration for CCC-ACS project can be found at http://clinicaltrials.gov/study/NCT02306616.

Accurate prediction of asymptomatic small abdominal aortic aneurysm (AAA) growth is crucial for risk stratification and personalized surveillance. This study developed an end-to-end deep learning framework to predict rapid expansion (≥0.5 cm/6 months) using computed tomography angiography (CTA) images from 81 asymptomatic patients with small AAA (30 rapid-growth and 51 stable patients). The pipeline integrated three core components: a ResNet50 classifier for identifying aortic images (99.86% accuracy, 99.91% F1-score), a YOLOv11 detector for localizing aneurysms (precision–recall: 0.902), and a MedMamba-based feature fusion model that combined imaging features with clinical metadata via multi-head self-attention. Model robustness was ensured through stratified 5-fold cross-validation and comprehensive data augmentation. The fusion model achieved a predictive accuracy of 98.75% and an F1-score of 97.78, outperforming seven classical deep learning backbones. Furthermore, explainability analyses confirmed the model’s reliance on established clinical risk factors and highlighted biologically plausible imaging regions for prediction. The proposed ResNet50–YOLOv11–MedMamba framework demonstrates the feasibility of automating AAA growth prediction directly from CTA and shows promising potential to enhance clinical decision-making.

ObjectiveIn hemodynamically stable patients with symptomatic abdominal aortic aneurysms (AAA), timely diagnosis of impending rupture remains a critical challenge. To address this, we developed and validated an interpretable multimodal deep learning model to assess rupture risk and support emergency decision-making.MethodsThis retrospective cohort study included 263 symptomatic AAA patients, with the most recent year's cases (n = 33) as an independent temporal test set. In the 230-patient development cohort, 75 impending rupture cases were matched 1:1 with 75 stable controls using propensity score for age, sex, and maximum aortic diameter. We developed a multimodal deep learning model that combines sequential CTA slices with six key clinical biomarkers through a bidirectional cross-attention (BCA) mechanism built on a ResNet-50 image encoder. For interpretability, we used Gradient-weighted Class Activation Mapping (Grad-CAM) and conducted pre-specified sensitivity analyses assessing robustness against endpoint decision-dependence, treatment-related data leakage, and domain shifts.ResultsIn the matched development test set (n = 30), our multimodal model achieved an area under the curve (AUC) of 0.898 with sensitivity and negative predictive value (NPV) both at 93.3%, offering a high safety margin for ruling out rupture. It markedly outperformed two pragmatic clinical baselines (clinical-rule model AUC: 0.751; CTA-sign model 0.778). This strong performance persisted in the independent temporal validation cohort (n = 33), where it attained an AUC of 0.880, sensitivity of 92.9%, and NPV of 87.5%. The proposed BCA fusion outperformed alternative architectures, and Grad-CAM visualizations were anatomically plausible in 78.8% of cases, supporting model interpretability.ConclusionWe developed and temporally validated an interpretable multimodal model that integrates CTA and clinical biomarkers to enable rapid AAA rupture risk stratification, offering a clinically relevant improvement in the safety and efficiency of emergency triage over current practice, pending prospective validation.

Background:Aortic intramural hematoma (IMH) is a subtype of acute aortic syndrome (AAS), and acute type B IMH, which mainly involves the descending thoracic aorta, is the most common form. Although conventional imaging markers have been used to predict outcomes, they mainly reflect focal or linear features. Area-related parameters on initial computed tomography angiography (CTA) images may provide a more accurate assessment of cross-sectional hematoma burden than traditional linear measurements. This study aimed to evaluate whether adding area-related CTA parameters improves prediction of 1-year aortic-related adverse events in patients with acute type B IMH. Methods:This study retrospectively reviewed admission and follow-up data from 290 patients with acute uncomplicated type B IMH. Patients were categorized into stable (N=180) and exacerbation (N=110) groups based on the occurrence of aortic-related adverse events within one year. By using least absolute shrinkage and selection operator (LASSO) regression combined with multivariate logistic regression, independent predictors were identified. A base model excluding area parameters and an enhanced model incorporating parameters such as hematoma area were constructed. The incremental prognostic value of hematoma area-related parameters was assessed using the net reclassification improvement (NRI), decision curve analysis (DCA), and internal validation with 1,000 bootstrap resamples. Results:Aortic arch involvement, abdominal aortic involvement, maximal descending aortic area (MDAA) >980 mm2, hematoma area ratio >37.5%, presence of ulcer-like projections (ULPs), and higher white blood cell (WBC) count were identified as independent predictors of progression. The enhanced model, which incorporated the area-based parameters (MDAA >980 mm2 and hematoma area ratio >37.5%), had better performance compared with the base model, with better discrimination [area under the curve (AUC) 0.745 vs. 0.664], improved reclassification (NRI 0.543), higher concordance index (C-index) (0.724 vs. 0.647), improved calibration (calibration slope 0.891 vs. 0.883; lower Emax 0.032 vs. 0.036), greater explanatory power (Nagelkerke R2 0.189 vs. 0.072), and higher clinical net benefit. Conclusions:Area-related imaging parameters have incremental prognostic value in patients with acute uncomplicated type B IMH and may help better identify high-risk patients and support more timely clinical decision-making in the future.

The current fragmented nature of research impedes a comprehensive understanding of the mechanistic pathways linking environmental exposure to emerging pollutants and their pathogenic outcomes. This study establishes a systematic framework linking bisphenol A (BPA) exposure to abdominal aortic aneurysm (AAA) development through integrated exposure modeling and cellular validation. Cross-species multi-omics analysis identified core targets, validated in vivo, revealing that BPA promotes AAA via TNF/NF-κB pathways, disrupting extracellular matrix remodeling, smooth muscle cell phenotype, inflammation, and senescence. Environmentally relevant BPA exposure altered key gene expression in vascular cells-Comp, Sdc2, and Sele in smooth muscle cells and macrophages; Comp, Ets1, Cd83, and Sele in endothelial cells; Comp, Lum, and Sele in fibroblasts-which also show prognostic potential. This work provides the first multiscale evidence chain from exposure to mechanism, improving BPA risk assessment and suggesting prevention targets for BPA-associated AAA.

Background:An elevated triglyceride-glucose (TyG) index is strongly linked to an increased risk of cardiovascular events in patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM). However, the potential impact of increasing diabetes duration on the association between the TyG index and cardiovascular risk remains unclear. Methods:Consecutive patients admitted for ACS with T2DM received PCI between March 2016 and March 2020 were enrolled in the analysis. A total of 7093 patients were categorized into tertiles according to the TyG index and T2DM duration. The primary outcome was ischemic events, composed of cardiac death, myocardial infarction, and/or stroke at 5 years. The main secondary outcomes were 5-year cardiac death and all-cause death. Interaction terms and non-linear associations of the TyG index with the clinical outcomes were examined across diabetes durations. Results:Over 5 years, 753 (10.6%) experienced ischemic events, 375 (5.3%) cardiac death, and 636 (9.0%) all-cause death. Higher TyG index and longer diabetes duration independently associated with all outcomes. Compared with the lowest TyG tertile, the highest tertile had adjusted hazard ratios (HRs) of 1.55 (95% CI: 1.29-1.88) for ischemic events and 1.23 (1.10-1.38) for all-cause death. The association between TyG index and ischemic events was strongest in the shortest duration group (HR: 1.43), with significant interaction for ischemic and cardiac death (both p < 0.05). Conclusions:A higher TyG index was independently associated with an increased risk of ischemic events and mortality among patients with ACS and T2DM. This association appeared to be attenuated with longer diabetes duration, suggesting that the prognostic relevance of the TyG index may vary according to the chronicity of diabetes.

Objective: There is limited evidence regarding the choice of P2Y12 receptor inhibitors as a component of dual antiplatelet therapy in patients with left main (LM) disease undergoing percutaneous coronary intervention (PCI). This study aimed to evaluate long-term clinical outcomes of ticagrelor- vs. clopidogrel-based dual antiplatelet therapy strategy in acute coronary syndrome (ACS) patients undergoing LM PCI. Methods: This is a post-hoc analysis from a prospective, single-center, real-world PCI registry. A total of 1,163 patients discharged post-ACS who underwent LM PCI and received ticagrelor or clopidogrel between March 2016 and March 2019 were included in the study. The primary endpoint was ischemic events at 12 months, including cardiac death, myocardial infarction, or stroke. Secondary outcomes included all-cause death and Bleeding Academic Research Consortium types 2, 3, and 5, and types 3 and 5 bleeding. Propensity score matching was used to adjust for bias due to confounders between the 2 groups. Results: The ticagrelor and clopidogrel groups comprised 529 (45.49%) and 634 (54.51%) patients, respectively. During the follow-up period, the rate of ischemic events was significantly lower with ticagrelor than with clopidogrel before (1.32% (7/529) vs. 3.63% (23/634), P = 0.013,6) and after propensity score matching (1.41% (6/425) vs. 4.00% (17/425), P = 0.020,1). The rates of all-cause death, Bleeding Academic Research Consortium-defined type 2, 3, and 5 bleeding, and type 3 and 5 bleeding were similar between the ticagrelor group and clopidogrel group before or after propensity score matching adjustment (all P > 0.05). Conclusion: Among patients with ACS undergoing LM PCI, ticagrelor use was associated with ischemic events benefit without excessive risk of bleeding at 12 months compared with clopidogrel.

Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores. This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding. The conservative group comprised 1767 (58.0

OBJECTIVE:We developed a risk stratification model to predict serious adverse hospitalization events (mortality, cardiac shock, cardiac arrest) (SAHE) after acute coronary syndrome (ACS) based on machine-learning models and logistic regression model. METHODS:This cohort study is based on the CCC-ACS project. The primary efficacy outcomes were SAHE. Clinical prediction models were established based on five machine-learning (XGBoost, RF, MLP, KNN, and stacking model) and logistic regression models. RESULTS:Among the 112 363 patients in the study, age (55-65 years: OR: 1.392; 95%CI: 1.212-1.600; 65-75 years: OR: 1.878; 95%CI: 1.647-2.144; ≥75 year: OR: 2.976; 95%CI: 2.615-3.393), history of diabetes mellitus (OR: 1.188; 95%CI: 1.083-1.302), history of renal failure (OR: 1.645; 95%CI: 1.311-2.044), heart rate (60-100 beats/min: OR: 0.468; 95%CI: 0.409-0.536; ≥100 beats/min: OR: 0.540; 95%CI: 0.454-0.643), shock index (0.4-0.8: OR: 1.796; 95%CI: 1.440-2.264; ≥0.8: OR: 5.883; 95%CI: 4.619-7.561), KILLIP (II: OR: 1.171; 95%CI: 1.048-1.306; III: OR: 1.696; 95%CI: 1.469-1.952; IV: OR: 7.811; 95%CI: 7.023-8.684), and cardiac arrest at admission (OR: 12.507; 95%CI: 10.757-14.530) were independent predictors of severe adverse hospitalization events for ACS patients. In several machine-learning models, RF (AUC: 0.817; 95%CI: 0.808-0.826) and XGBoost (AUC: 0.816; 95%CI: 0.807-0.825) also showed good discrimination in the training set, which ranked the first two positions. They also presented good accuracy and the best clinical benefits in the decision curve analysis. In addition, logistic regression was able to discriminate the SAHE (AUC: 0.816; 95%CI: 0.807-0.825) and performed the best prediction accuracy (0.822; 95%CI: 0.822-0.822) compared to several machine-learning models. Model calibration and decision curve analysis showed these prediction models have similar predictive performance. Based on these findings, we developed two CCC-ACS In-hospital Major Adverse Events Risk Scores and its online calculator. One is based on machine-learning model (https://ccc-acs-sae-3-xcnjsvoccusjwkfhfthh44.streamlit.app/), and another is based on logistic regression model (https://ccc-acs-sae-logistic-9te57ylnq3kazkeuyc7dub.streamlit.app/), offering a validated tool to predict survival for patients with ACS during hospitalization. CONCLUSIONS:Machine-learning-based approaches for identifying predictors of SAHE after an ACS were feasible and practical. Based on this, we developed two online risk prediction websites for clinicians' decision-making. The CCC-ACS-MSAE score showed accurate discriminative capabilities for predicting severe adverse hospitalization events and might help guide clinical decision-making. Key messages: Three research questions and three bullet points What is already known on this topic? Observational studies have identified risk factors for in-hospital death in patients with acute coronary syndromes (ACS). However, the real-world results of a large sample in China still need to be further explored. What does this study add? Machine-learning-based approaches for identifying predictors of SAHE after an ACS were feasible and practical. Based on these findings, we developed two CCC-ACS In-hospital Major Adverse Events Risk Scores and its online calculator. One is based on machine-learning model (https://ccc-acs-sae-3-xcnjsvoccusjwkfhfthh44.streamlit.app/), and another is based on logistic regression model (https://ccc-acs-sae-logistic-9te57ylnq3kazkeuyc7dub.streamlit.app/), offering a validated tool to predict survival for patients with ACS during hospitalization. How this study might affect research, practice, or policy? Early identification of high-risk ACS patients will help reduce in-hospital deaths and improve the prognosis of ACS patients.

Background: The stress hyperglycemia ratio (SHR) is a novel marker reflecting true acute hyperglycemic status and has been linked to adverse clinical outcomes in various settings. However, the clinical significance of SHR measured after percutaneous coronary intervention (PCI) remains inadequately explored. Objective: To investigate the relationship between post-procedural SHR and long-term prognosis in patients with coronary artery disease (CAD). Methods and Results: In this prospective cohort study, a total of 7,423 patients with complete baseline data were included. Kaplan-Meier survival analysis showed significant differences in the incidence of all adverse outcomes across SHR tertiles during a 2-year follow-up (Log-rank P?0.05). In multivariable Cox regression, patients in the highest SHR tertile had an independently increased risk of major adverse cardiovascular events (MACE) [adjusted HR (95% CI): 1.254 (1.046?1.502), P = 0.014], mainly attributable to higher risks of all-cause death [1.531 (1.076?2.177), P = 0.018] and cardiac death [1.702 (1.111?2.607), P = 0.014]. Restricted cubic spline analysis revealed a J-shaped association between SHR and the risk of MACE. Stratified analysis found that the effect of post-procedural SHR on prognosis was observed in patients with diabetes, regardless of the guideline-based criteria used to define glucose metabolism status, whereas no significant association was observed in those with normoglycemia or prediabetes. Conclusion: Elevated post-procedural SHR is independently associated with a higher risk of adverse cardiovascular outcomes in patients with CAD, particularly among those with diabetes. Assessment of post-procedural SHR may help refine risk stratification and guide individualized management in this population. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This prospective cohort study was observational in nature and did not involve any intervention; therefore, it was not registered in a clinical trial registry. ### Funding Statement This work was supported by the CAMS Innovation Fund for Medical Sciences (2023-I2M-C&T-B-061) ; the National High Level Hospital Clinical Research Funding (2024-GSP-TJ-8); the National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences (NCRC2022003). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The PROMISE cohort adhered to the principles of the Declaration of Helsinki and received approval from the Ethics Committee of Fuwai Hospital. Written informed consent was obtained from all participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets generated or analyzed during the current study are not publicly available due to the participants did not agree for their data to be shared publicly but are available from the corresponding author on reasonable request.

OBJECTIVE:This study assessed the effect of clopidogrel monotherapy versus extended Dual antiplatelet therapy (DAPT) on outcomes in patients with acute coronary syndromes (ACS) who have completed 9-12 months of DAPT after Percutaneous Coronary Intervention (PCI) and meet both high bleeding and high ischemia risk (birisk), stratified by Global Registry of Acute Coronary Events (GRACE) risk score. METHODS:In the OPT-BIRISK study, 7758 ACS Patients who completed 9-12 months of DAPT after PCI were randomized either to clopidogrel monotherapy or extended DAPT. This prespecified subgroup analysis categorized patients by GRACE score into intermediate-high-risk (>88) and low-risk (≤88) groups. The primary endpoint of the study was BARC 2, 3, or 5 bleeding. The key secondary endpoint was the rate of major adverse cardio-cerebral events (MACCE; the composite of all-cause death, myocardial infarction, stroke or clinically driven revascularization). FINDINGS:In low-risk patients, BARC 2, 3, or 5 bleeding occurred in 49 (2.7 %) with clopidogrel monotherapy versus 69 (3.6 %) with extended DAPT (HR 0.73, 95 % CI 0.50-1.05; p = 0.088).In intermediate-high-risk patients, clopidogrel monotherapy versus extended DAPT showed comparable BARC 2, 3, or 5 bleeding (2.3 % vs. 3.0 %; HR 0.77, 95 % CI 0.52-1.14; p = 0.8377), but significantly reduced MACCE (2.9 % vs. 4.1 %; HR 0.69, 95 % CI 0.49-0.97; p = 0.0332). In the overall trial population, there was no significant interaction between the GRACE score and treatment group for the primary or key secondary endpoints (P > 0.05 for all outcomes). CONCLUSIONS:Among birisk patients with ACS, clopidogrel monotherapy was associated with lower incidence of all bleeding events (BARC 1-5) versus extended DAPT regardless of GRACE score, but showed no significant difference in BARC 2, 3, or 5 bleeding. Moreover, it was associated with lower MACCE incidence versus extended DAPT in intermediate-high-risk groups.

Multivessel disease(MVD) is linked to a poorer prognosis, increased complications, longer hospital stays, and higher in-hospital mortality when compared to single-vessel disease(SVD).The purpose of this study is to explore the clinically relevant predictors of acute cornary syndrome (ACS) combined with MVD. This multicenter retrospective study included 68,378 ACS patients from 240 hospitals.The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the predictive factors for MVD. When compared to SVD group, the MVD group showed a higher incidence of Major Adverse Cardiovascular Events(MACCEs), including all-cause death, myocardial infarction, stent thrombosis, and ischemic stroke during hospitalization, These differences were found to be statistically significant (P < 0.05) .The multivariate analysis revealed that age over 75 years (OR: 1.246, 95

Abdominal aortic aneurysm (AAA) is the most prevalent dilated arterial aneurysm that poses a significant threat to older adults, but the molecular mechanisms linking senescence to AAA progression remain poorly understood. This study aims to identify cellular senescence-related genes (SRGs) implicated in AAA development and assess their potential as therapeutic targets. Four hundred and twenty-nine differentially expressed genes (DEGs) were identified from the GSE57691 training set, and 867 SRGs were obtained. Through the intersection of DEGs with SRGs, 19 differentially expressed senescence-related genes (DESRGs) were uncovered. Functional enrichment analysis was performed to explore their biological roles in AAA. To identify hub genes, we applied machine learning algorithms, including LASSO, SVM-RFE and random forest. These hub genes were then validated in two independent datasets. In the initial validation cohort, significant differences in the expression levels of BTG2, ETS1, ID1 and ITPR3 were observed between the AAA and control groups. Receiver operating characteristic (ROC) analysis demonstrated a robust diagnostic performance. Further validation across different AAA stages (small, large and ruptured AAA) identified ETS1 and ITPR3 as potential diagnostic genes. Subsequently, the diagnostic relevance of ETS1 and ITPR3 was further validated in human serum samples and mouse models of AAA. In addition, single-cell RNA sequencing suggests that senescent endothelial cells play a pivotal role in AAA progression, we further confirmed the correlation between ETS1 and ITPR3 and senescent endothelial cells by WB, IF and RT-qPCR. In conclusion, our study reveals the pivotal role of cellular senescence in AAA progression and identifies ETS1 and ITPR3 as promising diagnostic biomarkers.