BACKGROUND:The routine implementation of heart teams for patients with complex coronary artery disease (CAD) is challenging due to the insufficient multidisciplinary specialist resources for face-to-face discussion. A real-time heart team during the angiography, based on an online meeting, offers the potential to efficiently integrate resources. OBJECTIVES:In this study, we sought to evaluate the implementation value and safety of a "real-time heart team" decision making approach. METHODS:This noninferiority randomized controlled trial enrolled patients with de novo left main or 3-vessel CAD at 3 cardiac centers. Patients were randomly assigned to the conventional heart team group (discussed by a face-to-face meeting after the angiography) or the real-time heart team group (discussed by an online meeting during the angiography). Implementation value outcomes included care efficiency (waiting time for treatment, recatheterization, specialist workload, and economic outcomes) and process evaluation metrics (discussion adequacy, surgeon participation, and shared decision making). The safety outcomes were a composite of 1-year major adverse cardiovascular and cerebrovascular events (MACCE) (including all-cause mortality, myocardial infarction, stroke, unplanned revascularization, and readmission due to reangina) and revascularization decision making. RESULTS:Overall, 490 complex CAD patients were included, with 245 patients in each group. Waiting time for final therapy (median: 2 days [Q1-Q3: 0-7 days] vs 5 days [Q1-Q3: 2-10 days]; P < 0.001), recatheterization rate (12.5% vs 98.9%; P < 0.001), specialist high workload rate (5.3% vs 29.0%; P < 0.001), and percutaneous coronary intervention (PCI) hospitalization cost (percentage of decrease: 18.0%; P < 0.001) were significantly reduced in the real-time group. More discussion time spent (4.0 ± 1.8 min vs 3.4 ± 1.6 min), better specialist satisfaction (based on NASA Task Load Index scale), more chief surgeon participation (26.5% vs 18.8%), but less multidisciplinary synchronous shared decision making (2.0% vs 11.5%) were found in the real-time group. The real-time heart team group was noninferior to the conventional group in 1-year MACCE (8.2% vs 10.6%; risk difference: -2.45%; 95% CI: -7.61%-2.71%; P for noninferiority < 0.001). The proportions of PCI, coronary artery bypass grafting, and medical therapy were similar between the 2 groups (P = 0.892). CONCLUSIONS:Compared with the conventional heart team, the real-time heart team significantly improved care efficiency and process evaluation metrics, with similar clinical outcomes and decision making. However, insufficient shared decision making and intercenter generalizability should be optimized before widespread implementation of this approach. (Feasibility and Effectiveness of a Real-Time Heart Team Approach in Complex CAD [EHEART; NCT05514210]).

Abstract The association of pulse pressure (PP) with the severity and cardiovascular (CV) outcomes in stable coronary artery disease populations with normal ejection fraction are sparse. We enrolled 7,027 patients and follow-up 36.4 months, a total of 289 events occurred. Both systolic blood pressure (SBP) and PP were significantly increased by Gensini Score quartiles. Meanwhile, the percentage of 3-diseased vessels was increasing by PP quartiles (p < 0.001). On univariate analysis, both PP and SBP were associated with CV death, stroke, and combined outcome (p < 0.05, all). However, after adjusting for potential confounders, PP remains significantly associated with stroke (HR 95%CI 1.019[1.005–1.033]) and combined outcome (HR 95%CI 1.014[1.005–1.023]) while SBP was only associated with stroke (HR 95%CI 1.014[1.003–1.026]). On multivariate analysis, the highest PP quartile consistently associated with stroke and combined outcome (p < 0.05, all). This prospective cohort study suggesting that PP may be a pivotal predictor for CV risk.

A key yet often overlooked factor in the unpredictable failure of degradable systems is “acquired”; heterogeneity—a spatially and temporally evolving unevenness of degradation that emerges and aggravates during service, rather than originating from manufacturing defects. Controlling this inherent randomness is particularly critical for biodegradable implants, where corrodible metals offer the necessary strength but are susceptible to such unpredictable localized weakness throughout the therapeutic window. Herein, we propose that the reliability of a biodegradable device is highly dependent upon the extent of such “acquired”; heterogeneity. We derive an equation set of random degradation inspired by the Poisson raindrop question, and employ them to quantify the acquired heterogeneity of biometals with and without polymer coatings. We find that coating iron with polylactide increases the corrosion rate by 3-fold but reduces the inhomogeneity by 4,000-fold in a blood-mimetic medium, surprisingly leading to later device fracture despite faster degradation. The resulting biodegradation-controlled metal-polymer composite stents for interventional treatment prevent high-risk early and random fractures. Preclinical studies in pigs, clinical trials involving 1108 patients across multiple cohorts, and 5-year outcomes of 45 first-in-human implantations illustrate that the biodegradation-controlled metal-polymer composite stents are safe, durable, and reliable. Our theoretical framework is relevant to any discipline in which random tempospatial variability undermines system performance.

We present a novel simple and easy-to-use 3D wiring technique for coronary chronic total occlusions (CTOs) named ZOLUTION-Zero OverLap View Universal Three dimensIONal wiring. ZOLUTION can be used for: (1) Distal cap puncture, (2) CTO body wiring, (3) Retrograde wiring, and (4) Reverse controlled antegrade and retrograde tracking (reverse CART). The four steps of ZOLUTION are: (1) Find the zero-degree overlap fluoroscopic view where the wire shaft and the vessel target are overlapping. (2) Straighten the wire tip by minuscule rotation. (3) Move to a coaxial view 35-70 degrees away (Secondary view) to check that the wire is pointing toward the target (if not, rotate the wire 180 degrees and re-straighten the wire tip in ZOV). (4) In the secondary view puncture forward with the wire toward the target. ZOLUTION does not require formation of a mental map, specific angiographic views of that coronary segment, or fluoroscopic views to be 90-degree apart. It is superior to traditional 3D wiring as it provides a precise angle that is aimed at the target increasing its success rate. We believe ZOLUTION can be universally adopted due to its simplicity and could greatly improve CTO PCI efficiency and safety.

BACKGROUND:A myocardial bridge (MB) is frequently observed after recanalization of a left anterior descending coronary artery (LAD) chronic total occlusion (CTO); however, the long-term prognostic impact of MBs in this specific setting remains controversial. OBJECTIVES:The aim of this study was to determine the impact of MBs on long-term outcomes in patients undergoing percutaneous coronary intervention of LAD CTOs. METHODS:Consecutive patients with LAD CTOs who underwent intravascular ultrasound-guided percutaneous coronary intervention from January 2019 to December 2021 were retrospectively analyzed. The primary endpoint was the 5-year rate of major adverse cardiac events (MACE), a composite of cardiac death, spontaneous myocardial infarction, and ischemia-driven revascularization. RESULTS:Among 685 patients analyzed, MBs were identified in 393 (57.4%) on intravascular ultrasound; stent extension into the bridged segment occurred in 44.3% of these cases (174 of 393). After a median 5-year follow-up, patients with MBs had a higher incidence of MACE compared with those without MBs (16.1% vs 8.9%; P = 0.006), driven primarily by more ischemia-driven revascularization in the MB group (15.1% vs 7.9%; P = 0.004). Stent extension into the MB was associated with a higher rate of MACE compared with sparing the MB (21.4% vs 11.9%; P = 0.0017). MACE rates did not differ between patients with MBs spared from stenting and those without MBs (11.9% vs 8.9%; P = 0.25). CONCLUSIONS:MBs are prevalent after LAD CTO recanalization. Although their presence is associated with adverse outcomes, the risk is driven mainly by stent extension into the bridged segment.

Introduction Patients with acute myocardial infarction (AMI) and multivessel disease are at elevated risk of recurrent events. Radial wall strain (RWS), a novel indicator derived from angiography, has emerged as a potentially useful adjunct to optical coherence tomography (OCT) for assessing plaque vulnerability. The NASCENT trial is a prospective, multicentre cohort study designed to assess the natural history of coronary plaque in this high-risk AMI population and investigate the predictive value of angiography-based RWS for lesion progression, compared with OCT-assessed vulnerable plaque.Methods and analysis Following successful culprit lesion revascularisation for AMI patients with multivessel disease, we assessed eligible non-culprit lesions (30%–80% diameter stenosis) in non-flow-limiting, non-infarct-related arteries (Murray law-based quantitative flow ratio >0.80) using OCT and offline RWS analysis. The primary endpoint is lesion progression at 1 year, defined as a ≥20% increase in diameter stenosis percentage measured by quantitative coronary angiography. Between April 2024 and April 2025, 131 patients were enrolled. The 1-year angiographic and OCT follow-ups will be completed by May 2026. Clinical follow-ups are planned at 1 month, 6 months, 1 year and annually up to 3 years. As the first prospective trial comparing angiography-based RWS with OCT for predicting lesion progression in the AMI population, this study may provide crucial evidence for RWS as a valuable tool for risk stratification and clinical decision-making.Ethics and dissemination The protocol has been approved by the Institutional Review Board and Ethics Committee (Fuwai Hospital Approval No. 2023-2039) and will be conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants. The study results will undergo peer-reviewed publication.Trial registration number NCT06040073.

Background: Infectious disease surveillance systems face methodological limitations in early warning capabilities, particularly in integrating correlated indicators, assessing healthcare system impacts, and synthesizing diverse data streams into actionable intelligence. We aimed to develop and validate a hierarchical signal amplification algorithm generating daily risk scores for regional infectious disease assessment. Methods: In this retrospective observational study in Chongqing, China (population 32.1 million; 2023–2024), we constructed a dual-dimensional framework integrating transmission potential (n = 5) and healthcare system impact (n = 8) indicators with nonlinear aggregation mechanisms. The framework was assessed across respiratory infections, intestinal diseases, and hand-foot-and-mouth disease. Results: The integrated risk assessment system achieved 83.92 % sensitivity and 88.62 % specificity at risk score 5. Detection capabilities varied by disease category: respiratory infections (98.53 % sensitivity), intestinal diseases (89.39 %), and hand-foot-and-mouth disease (65.22 %). Early warning lead times reached 11, 7, and 6 days respectively. System stability was validated through Monte Carlo simulation (consistency index 0.96). Conclusions: The hierarchical signal amplification approach transforms diverse surveillance data into a daily regional risk score that provides substantial lead times for preemptive public health action while maintaining signal integrity across multiple transmission patterns.

Influenza activity peaks in southern (59.62%) and northern China (57.60%) during the 2022/2023 season reached the highest levels in the past 10 years. The 2023/2024 season witnessed a longer duration of the winter-spring epidemic weeks and a higher disease burden compared with previous high-epidemic years. The A(H3N2), A(H1N1)pdm09, and B/Victoria lineages alternated among the predominant circulating strains from the 2022/2023 season to the 2024/2025 season. After the 2022/2023 and 2023/2024 seasons of disruption and fluctuation, influenza in the 2024/2025 season has reverted to its previous epidemic pattern.

BACKGROUND:Intensive blood pressure (BP) control in patients with low muscle mass on cardiovascular (CV) and cognitive outcomes remains unclear. Therefore, we aim to examine the impact of intensive BP control on CV and cognitive outcomes in patients with low muscle mass. METHODS:Data from the Systolic Blood Pressure Intervention Trial (SPRINT) were utilized to estimate muscle mass. We employed Cox proportional hazard models and generalized linear models to explore how muscle mass status influences the efficacy of intensive BP control on both cardiovascular and cognitive outcomes on relative and absolute scales. Landmark analyses with cutoffs at 3.4 and 2 years assessed primary outcomes. RESULTS:Among 6,367 randomized participants, 469 (7.4%) had baseline low muscle mass. Intensive BP control resulted in a 5.2 events per 1,000 person-years reduction in absolute risk (hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.58-0.89) in patients with normal muscle mass. Conversely, it increased the absolute risk of primary cardiovascular events by 11.1 per 1,000 person-years in those with low muscle mass (HR, 1.72; 95% CI, 0.89-3.34; P = 0.013 for interaction), and led to a significantly higher rate of primary cardiovascular events compared to standard treatment after 3.4 years (P = 0.043). Regardless of the presence of low muscle mass, intensive BP control can reduce both the relative and absolute risks of cognitive outcomes, with all interaction P-values > 0.05. CONCLUSIONS:In persons with low muscle mass, intensive BP control was associated with an increased risk for CV events but not for cognitive decline.

AIMS:The cardiovascular-kidney-metabolic (CKM) health approach emphasizes the importance of multidisciplinary early-stage disease prevention. This study aimed to explore sex differences in CKM risk factors associated with common degenerative valvular heart disease (VHD). METHODS AND RESULTS:A total of 436 184 participants (54.4% women; mean age, 58 years) free of VHD or heart failure at baseline and with complete information about CKM risk factors were included from the UK Biobank cohort. We assessed sex differences in hazard ratios (HRs) and population-attributable risk (PAR) for incident VHD and VHD-related interventions or mortality, focusing on five CKM risk factors: hypertension, diabetes, obesity, hypertriglyceridaemia, and chronic kidney disease (CKD). At baseline, 81.06% of participants had one or more CKM risk factors: 75.61% had hypertension, 4.80% had diabetes, 24.14% had obesity, 22.26% had hypertriglyceridaemia, and 2.32% had CKD. Over a median follow-up period of 13.80 years, incidences of aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR) were 11.18 and 5.42, 3.64 and 2.19, and 10.39 and 6.94 events per 10 000 person-years for men and women, respectively. Hypertension was consistently the largest attributable risk factor for incident VHD in both sexes, with PARs of 29.07% and 25.17% for AS, 24.21% and 16.51% for AR, and 19.55% and 13.01% for MR in women and men, respectively. Compared with men, women had higher risks of AS with obesity [HR: 1.17 (1.04-1.32)], AR with CKD [1.59 (1.01-2.49)], and MR with either hypertension [1.25 (1.07-1.47)] or hypertriglyceridaemia [1.22 (1.07-1.39)]. CONCLUSION:Tailoring the prioritization of CKM risk factors based on gender has the potential to enhance the effectiveness of VHD prevention strategies. LAY SUMMARY:Despite the rising incidence of degenerative valvular heart disease (VHD), recommended preventive interventions are lacking. This large-scale study examined sex disparities in the relationship between the cardiovascular-kidney-metabolism (CKM) health construct, as proposed by the American Heart Association, and degenerative VHD in a cohort of UK adults. This study provided a comprehensive investigation into CKM risk factors for degenerative VHD. Hypertension was the largest attributable risk factor for incident VHD in both sexes. Females showed higher risks for specific VHD subtypes when certain CKM risk factors were present. Specifically, females had higher risks of aortic valve stenosis with obesity, aortic valve regurgitation with chronic kidney disease, and mitral valve regurgitation with either hypertension or hypertriglyceridaemia, compared with males. Our study findings indicate that customizing risk factor prioritization based on gender may enhance the precision and effectiveness of prevention strategies for degenerative VHD, with particular emphasis on female CKM health.

ABSTRACT This study aimed to investigate the effect of lipoprotein(a) (Lp(a)) on major adverse cardiovascular events (MACEs) among individuals with chronic coronary syndrome (CCS) according to ABO blood groups. Two independent cohorts of patients with CCS were included consecutively. Blood groups and Lp(a) levels were measured. Patients with the AB group were excluded due to the small sample size. In the exploratory cohort (n = 7611), 560 MACEs were recorded over a mean follow‐up of 54.80 months. Stratification analysis revealed that the relationship of elevated Lp(a) levels with prognosis was more pronounced in patients with blood group A or B. Patients with blood group A or B plus medium Lp(a) (HR, 1.93, 95% CI: 1.24–3.01) or high Lp(a) (HR, 2.06, 95% CI: 1.32–3.24) concentrations had a significantly higher risk of MACEs compared to those with blood group O and low Lp(a) levels. Similar results were obtained in the confirmatory cohort (n = 7916). In conclusion, our data demonstrated for the first time a more prominent association between Lp(a) and adverse outcomes in CCS patients with non‐O blood group compared to those with blood group O, suggesting that ABO blood group measurement may be clinically useful for decision‐making in Lp(a) intervention.