The Bleeding Academic Research Consortium (BARC) classification was proposed to standardize bleeding endpoint definitions and reports in cardiovascular clinical trials. However, its prognostic value has not been fully validated in East Asian patients with acute myocardial infarction (AMI) who have a higher bleeding risk than Western populations do.We analyzed bleeding events (types 2 or 3) based on the BARC classification in 13,657 patients with AMI (mean age 64.9 ± 12.7 years) from nationwide prospective registries in Japan and Korea. The primary endpoint was all-cause mortality during the 1-year clinical follow-up.During the 1-year follow-up, BARC type 2 or 3 bleeding occurred in 5.5% of the patients (n = 759). Patients who experienced BARC type 2 or 3 bleeding had a significantly higher risk of mortality compared with those without bleeding (hazard ratio [HR] 4.1, 95% confidence interval [CI] 3.4-4.8, p < 0.001). The risk of mortality was higher in BARC type 3 (HR 6.4, 95% CI 5.1-7.9) than in type 2 bleeding (HR 2.4, 95% CI 1.8-3.1). BARC type 2 or 3 bleeding remained significantly associated with increased mortality after adjustment (adjusted HR 1.9, 95% CI 1.5-2.5, p < 0.001). Similar associations with mortality were observed when each BARC classification (type 2 and 3) was analyzed individually.In East Asian patients with AMI, BARC-defined bleeding events were significantly associated with increased mortality. These findings support the adoption of the BARC classification to predict mortality, particularly in East Asian patients with AMI.

Background/aimsDespite cumulative evidence of superior outcomes for acute myocardial infarction (AMI) with normal left ventricular ejection fraction (LVEF) compared to those for AMI with reduced LVEF, real-world evidence on outcomes of patients with AMI and supranormal LVEF (snLVEF) is lacking. Therefore, this study aimed to evaluate the clinical outcomes of patients with AMI and snLVEF.MethodsA total of 27,903 patients with AMI were included from the Korean nationwide AMI cohort between November 2011 and June 2020 after excluding those with unmeasurable LVEF. Patients were classified into four groups according to LVEF: supranormal (≥65%), normal (50%–64%), mid-range (40%–49%), and reduced (<40%). The primary outcome was 3-year all-cause mortality.ResultsAcross four hierarchical Cox models, snLVEF was consistently associated with lower 3-year all-cause mortality compared with normal LVEF (a crude model HR 0.71; 95% CI 0.58–0.87; a fully-adjusted model HR 0.77; 95% CI 0.60–0.98), with similar estimates observed in intermediate models.ConclusionsPatients with AMI and snLVEF experienced the best clinical outcomes with the lowest mortality across the four groups.

Background:Hyperhomocysteinemia is a well-established risk factor for arterial and venous thromboembolism. Among the various aetiologies, a homozygous C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene impairs the remethylation of homocysteine, promoting a prothrombotic milieu. However, simultaneous manifestations of pulmonary thromboembolism and aortic thrombosis remain exceedingly rare and clinically underrecognized. Case summary:We report a case of a 58-year-old male who presented with acute dyspnoea. Chest computed tomography angiography revealed bilateral pulmonary thromboembolisms and extensive mural thrombi in the thoracic and abdominal aorta. Laboratory findings demonstrated markedly elevated plasma homocysteine (>50 µmol/L) and a folate deficiency, and genetic analysis confirmed homozygosity for the MTHFR C677T mutation. The patient also had a history of acute myocardial infarction and ischaemic stroke suggestive of a chronic thrombotic diathesis. The patient was managed with intravenous anticoagulation and daily supplementation with vitamin B6 and folate, with gradual clinical improvement. Discussion:This case highlights the systemic thrombotic consequences of inherited hyperhomocysteinemia caused by a homozygous MTHFR C677T mutation. In the absence of conventional risk factors, the coexistence of arterial and venous thromboses underscores the importance of the early detection of genetic predispositions in patients with unexplained or recurrent thromboembolic events. Targeted metabolic correction, including folate repletion, may help attenuate the residual vascular risk in this subset of patients.

Background High bleeding risk (HBR) is associated with an increased risk of both ischemic and bleeding events and is known to have a worse prognosis than non‐HBR in patients with acute myocardial infarction. However, data regarding the prognostic impact of complete revascularization (CR) in acute myocardial infarction and multivessel disease patients complicated by HBR remain limited. Methods A total of 13 460 patients with acute myocardial infarction and multivessel disease who underwent successful percutaneous coronary intervention for infarct‐related artery were selected from the nationwide Korean registry from 2011 to 2020. Primary outcome was major adverse cardiac and cerebrovascular events during 3 years of follow‐up. Results Of the 13 460 patients, 4401 (32.7%) were classified as the group with HBR according to modified Academic Research Consortium‐HBR criteria and 1577 patients (35.8%) underwent CR. Among the group without HBR, 3911 patients (43.2%) underwent CR for noninfarct‐related artery. The group with HBR had significantly higher risk of major adverse cardiac and cerebrovascular events (non‐HBR versus HBR; 16.4% versus 35.7%; adjusted hazard ratio [HR], 1.70 [95% CI, 1.56–1.85]; P<0.001) and Bleeding Academic Research Consortium type 2 or greater bleeding (4.5% versus 10.4%; adjusted HR, 1.63 [95% CI, 1.38–1.94]; P<0.001) than the group without HBR. Patients who underwent CR were associated with lower risk of major adverse cardiac and cerebrovascular events at 3 years than those with incomplete revascularization in both groups with HBR (40.0% versus 28.1%, adjusted HR, 0.65 [95% CI, 0.55–0.75], P<0.001) and without HBR (19.0% versus 13.1%, adjusted HR, 0.71 [95% CI, 0.63–0.80], P<0.001). The incidence of bleeding events was similar between the CR and incomplete revascularization groups in both groups with HBR (10.7% versus 10.0%, adjusted HR, 1.07 [95% CI, 0.84–1.37], P=0.572) and without HBR (4.2% versus 5.0%, adjusted HR, 0.98 [95% CI, 0.78–1.23], P=0.867). Conclusions In patients with acute myocardial infarction and multivessel disease, CR was associated with a lower risk of major adverse cardiac and cerebrovascular events compared with incomplete revascularization in both HBR and non‐HBR. Registration KAMIR‐NIH; KCT‐0000863, KAMIR‐V; KCT‐0008355.

Background:Limited data are available on clinical characteristics and outcomes in patients with culprit or non-culprit left main coronary artery (LMCA) stenosis between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Methods:This study aimed to compare treatment pattern and outcome between STEMI and non-STEMI according to culprit and non-culprit LMCA stenosis. We examined 572 patients with LMCA stenosis from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, nonfatal myocardial infarction (MI), repeat revascularization, cerebrovascular accident, rehospitalizations, and stent thrombosis. Results:In patients with culprit LMCA stenosis, cardiogenic shock (50.5% vs. 12.1%; P < 0.001) and use of mechanical hemodynamic support (48.5% vs. 11.0%; P < 0.001) were significantly greater in STEMI than in non-STEMI. In-hospital mortality (32.3% vs. 8.1%, P < 0.001) and 3-year MACCE (56.6% vs. 42.2%; log-rank P = 0.003) were significantly higher in STEMI. Intravascular ultrasound improved outcomes of culprit LMCA stenosis (23.1% vs. 68.1%, log-rank P = 0.001). Acute kidney injury, multiple organ failure, and cardiopulmonary resuscitation were independently associated with MACCE in STEMI. In patients with non-culprit LMCA stenosis, there were no significant differences in MACCE between STEMI and non-STEMI (31.3% vs. 34.8%, log-rank P = 0.530). Concurrent percutaneous coronary intervention (PCI) for non-culprit LMCA stenosis during PCI for other culprit vessel segments did not improve MACCE in STEMI (29.5% vs. 32.9%; log-rank P = 0.660). Conclusions:PCI for culprit LMCA stenosis is challenging in both STEMI and non-STEMI despite appropriate mechanical hemodynamic support. Concurrent PCI for non-culprit LMCA stenosis in STEMI does not improve MACCE.

BACKGROUND:Renal dysfunction increases adverse outcomes in non-ST-segment elevation myocardial infarction (NSTEMI), but evidence comparing percutaneous coronary intervention (PCI) with non-PCI by renal function is limited. OBJECTIVES:The authors aimed to compare 3-year outcomes of PCI versus non-PCI by baseline renal function in NSTEMI. METHODS:We stratified 15,255 NSTEMI patients by estimated glomerular filtration rate (eGFR; ≥90, 60-89, 30-59, and <30 mL/min/1.73 m2). Primary outcome was 3-year major adverse cardiac and cerebrovascular events (MACCE; defined as all-cause death, recurrent myocardial infarction, or stroke). Multivariable-adjusted Cox regression was performed. Median follow-up was 36.0 months (IQR: 36.0-36.0 months; 40,097 person-years). RESULTS:Worsening renal function was associated with higher MACCE and mortality (all P < 0.001), except between eGFR ≥90 and 60-89. Compared with non-PCI, PCI was associated with lower adjusted risks in the eGFR 60-89, 30-59, and <30 strata, respectively, regarding MACCE (HR [95% CI]: 0.58 [0.47-0.71]; 0.66 [0.53-0.82]; 0.60 [0.48-0.75]), all-cause mortality (HR [95% CI]: 0.47 [0.37-0.60]; 0.57 [0.45-0.72]; 0.59 [0.47-0.76]), and cardiovascular mortality (HR [95% CI]: 0.48 [0.34-0.66]; 0.53 [0.39-0.70]; 0.56 [0.41-0.75]) (all P < 0.001), but not in eGFR ≥90 MACCE (HR: 0.83 [95% CI: 0.64-1.07]; P = 0.158). Significant interaction was observed only for all-cause mortality (P = 0.044). CONCLUSIONS:In NSTEMI, worsening renal function was associated with higher long-term adverse outcomes. PCI was associated with lower risks across most renal function strata, but not in eGFR ≥90.

Background Acute myocardial infarction is associated with substantial mortality risk that persists beyond the acute phase. Many existing post–acute myocardial infarction risk models were developed before contemporary advances in treatment, potentially limiting their relevance in current practice. We aimed to develop simplified machine learning–based models to predict short‐ and long‐term mortality after acute myocardial infarction in a contemporary therapeutic context. Methods The Korean Artificial Intelligence–Based Risk Model for Acute Myocardial Infarction (KARMA) was developed to predict 3‐month and 3‐year mortality using a boosted decision tree algorithm. Model development and internal validation were performed using the KAMIR (Korea Acute Myocardial Infarction Registry)–National Institutes of Health registry (2011–2015), with external validation in the KAMIR‐V registry (2016–2020). Seven routinely available clinical variables were included. Results The KARMA models demonstrated excellent discrimination for both early and late mortality. Areas under the receiver operating characteristic curves for 3‐month KARMA and 3‐year KARMA were 0.91 (95% CI, 0.88–0.94) and 0.85 (95% CI, 0.82–0.87), respectively, significantly outperforming the GRACE (Global Registry of Acute Coronary Events) score (3‐month score: 0.79; 3‐year score: 0.80) and the KAMIR score (3‐month score: 0.84; 3‐year score: 0.82). Kaplan–Meier curves showed clear and sustained separation across KARMA risk groups. Predictive performance was consistent across subgroups defined by age, sex, MI type, left ventricular dysfunction, and renal dysfunction. External validation in the KAMIR‐V cohort confirmed robust performance (area under the receiver operating characteristic curve, 0.92 for 3‐month and 0.86 for 3‐year mortality). Conclusions The KARMA scores provide a reliable and readily accessible tool for predicting short‐ and long‐term post–acute myocardial infarction mortality. Identification of high‐risk individuals would enable providers to optimize management strategies that could improve outcomes.

Limited data exist regarding the real-world practices and clinical outcomes in patients with ischemic heart failure with reduced left ventricular ejection fractions (LVEFs). Using nationwide registry data from South Korea, we aimed to investigate long-term outcomes and clinical practices, especially implantable cardioverter defibrillators (ICDs) implantation, in patients with reduced LVEFs at least 40 days after acute myocardial infarction (AMI). Of 13,056 patients with AMI between 2011 and 2015, we analyzed 350 (median age, 66 years [interquartile range, 56-75]) who had LVEFs <40% on follow-up transthoracic echocardiogram 40 days after the index event. The primary outcome was cardiac-cause mortality at 3 years. Secondary outcomes comprised major cardiovascular events as well as outcomes defined by the use of ICDs, cardiac resynchronization therapy defibrillators (CRT-Ds), and electrophysiology studies. Among 350 patients, 39 (11.1%) died from cardiac causes during 3 years of follow-up. Eleven (3.1%) were hospitalized for ventricular tachycardia. The rate of ICD or CRT-D implantation up to 3 years was 5.7% (20/350). Cox time-to-event analysis revealed older age, LVEF <30%, diabetes mellitus, and previous MI or revascularization as positively associated with cardiac death, whereas the use of statins and body weight <67 kg were negatively associated. This nationwide Korean registry demonstrated that only 5.7% of patients who had reduced LVEFs after 40 days of AMI underwent ICD implantations over 3 years. Considering the high mortality, concerted efforts are needed to improve clinical outcomes for patients who may have been candidates for ICD implantation.

Background Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention improves patient outcomes, yet the impact of a center's IVUS experience on long-term outcomes remains unclear. We evaluated whether the prognostic association of IVUS-guided percutaneous coronary intervention in patients with acute myocardial infarction differs based on a center's level of IVUS use. Methods We retrospectively analyzed 9752 patients with acute myocardial infarction treated with second-generation drug-eluting stents from the KAMIR-NIH (Korean Acute Myocardial Infarction Registry-National Institutes of Health). The primary outcome was 3-year major adverse cardiovascular events, defined as a composite of all-cause death, myocardial infarction, and coronary revascularization. The secondary outcome was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target lesion revascularization. Centers were classified into higher- or lower-IVUS-use groups on the basis of median institutional usage (10.3%). Results In higher-use centers, IVUS-guided percutaneous coronary intervention was associated with lower rates of major adverse cardiovascular events (15.3% versus 18.5%, P=0.016) and target-lesion failure (6.3% versus 8.3%, P=0.039) in propensity score-matched populations. Multivariate Cox analysis confirmed lower risks of major adverse cardiovascular events (hazard ratio [HR], 0.80 [95% CI, 0.69-0.93]; P=0.003) and target-lesion failure (HR, 0.75 [95% CI, 0.59-0.93]; P=0.01). Conversely, in lower-use centers, IVUS guidance was not associated with significant differences in major adverse cardiovascular events (15.7% versus 18.6%, P=0.422) or target-lesion failure (8.9% versus 10.4%, P=0.644). Conclusions The association of IVUS-guided percutaneous coronary intervention with lower adverse event rates was more apparent and statistically demonstrable in centers with higher IVUS use. These findings suggest that institutional experience may amplify the observable impact of IVUS guidance, underscoring the potential value of standardized IVUS implementation in acute myocardial infarction management.

Introducción y objetivos A pesar del pronóstico favorable tras la intervención coronaria percutánea (ICP) guiada por imagen endovascular (IVI) para lesiones coronarias complejas, aún no está claro si la ICP guiada por IVI para lesiones coronarias complejas en pacientes con infarto agudo de miocardio (IAM) sería beneficiosa según la clasificación de lesiones ACC/AHA. Métodos Se hizo un análisis combinado a nivel de paciente de 2 registros nacionales de IAM de Corea. De los registros KAMIR-V y KAMIR-NIH, se incluyó a un total de 23.051 pacientes que se sometieron con éxito a una ICP en la arteria relacionada con el infarto, estratificados según la clasificación de lesiones ACC/AHA. Se compararon los resultados clínicos entre ICP guiada por IVI e ICP guiada por angiografía. El criterio de valoración principal fue la aparición de eventos cardiacos adversos mayores (MACE), una combinación de muerte cardiaca, IAM, revascularización repetida y trombosis del stent a los 3 años. Resultados La ICP guiada por IVI mostró una menor incidencia de MACE en comparación con la ICP guiada por angiografía en pacientes con lesiones tipo B2/C (HR ajustada=0,78; IC95%, 0,70-0,88; p <0,001), pero no en aquellos con lesiones tipo A/B1 (HR ajustada=0,81; IC95%, 0,60-1,11; p=0,190). Tanto en el IAM sin elevación del segmento ST como en el IAM con elevación del segmento ST, se observó un riesgo significativamente menor de MACE tras ICP guiada por IVI en comparación con la guiada por angiografía en pacientes con lesiones tipo B2/C (IAM sin elevación del segmento ST: HR ajustada=0,73; IC95%, 0,63-0,84; p <0,001; IAM con elevación del segmento ST: HR ajustada=0,86; IC95%, 0,75-0,98; p=0,027), pero no en aquellos con lesiones tipo A/B1. Conclusiones En pacientes con IAM, la ICP guiada por IVI mostró un riesgo significativamente menor de MACE en aquellos con lesiones tipo B2/C, pero no en aquellos con lesiones tipo A/B1. El beneficio pronóstico de la ICP guiada por IVI aumentó a medida que los pacientes presentaban características de lesión más complejas en la arteria relacionada con el infarto.

BACKGROUND/AIMS:Residual inflammatory risk after acute myocardial infarction (AMI) remains an important determinant of long-term outcomes despite optimal lipid-lowering therapy. The prognostic significance of serial high-sensitivity C-reactive protein (hs-CRP) measurements beyond the acute phase remains unclear. This study compared baseline and 1-year hs-CRP for predicting 3-year major adverse cardiovascular events in patients with AMI undergoing percutaneous coronary intervention. METHODS:We analyzed a large prospective AMI registry in which hs-CRP was measured at baseline and 1 year, classifying patients at each time point using a ≥ 2 mg/L threshold. The primary endpoint was 3-year MACE, including cardiovascular death, recurrent myocardial infarction, stroke, repeat revascularization, and stent thrombosis. RESULTS:Among 16,371 patients, 9,618 (58.8%) had elevated hs-CRP at baseline. Of the 5,389 patients with 1-year data, 28.9% had elevated hs-CRP. Baseline hs-CRP predicted MACE within the first year (hazard ratio [HR] 1.38, 95% CI 1.21-1.57); however, this association was no longer significant beyond 1 year. One year hs-CRP independently predicted subsequent 2-year MACE (HR 1.33, 95% CI 1.01-1.77). Patients with persistently high hs-CRP (≥ 2 mg/L at both time points) had the highest 3-year MACE risk (HR 1.49, 95% CI 1.08-2.06, p = 0.015 vs. persistently low group) than patients with recovered, worsening, and persistently low hs-CRP. CONCLUSION:In patients with AMI, hs-CRP measured at 1-year provides stronger long-term prognostic information than that at baseline beyond 1 year. Routine assessment of hs-CRP may improve risk stratification and guide targeted anti-inflammatory strategies in secondary prevention.

BACKGROUND AND OBJECTIVES:The optimal P2Y12 inhibitor for patients with acute myocardial infarction and renal impairment (AMI-RI) remains unclear, particularly in East Asian populations. This study compared the real-world effectiveness and safety of initial ticagrelor versus clopidogrel therapy in Korean patients with AMI-RI. METHODS:We analyzed 7,590 patients with AMI-RI (estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m²) from a nationwide multicenter registry. Of these, 3,793 received ticagrelor and 3,797 received clopidogrel as initial P2Y12 therapy. The primary efficacy endpoint was major adverse cardiac and cerebrovascular events (MACCEs), and the primary safety endpoint was clinically significant bleeding. Propensity score matching (PSM) was performed to adjust for baseline differences. RESULTS:At 1 year, after PSM (n=1,869 per group), no significant differences were observed between ticagrelor and clopidogrel in the primary efficacy endpoint (MACCE; hazard ratio [HR], 0.810; p=0.212) or clinically significant bleeding (HR, 1.056; p=0.795). Renal function-stratified analyses showed consistent outcomes across eGFR categories, with no significant differences in MACCE after adjustment. During follow-up, a substantial proportion of patients initially treated with ticagrelor switched to clopidogrel, whereas most patients in the clopidogrel group maintained their initial therapy. CONCLUSIONS:Among Korean patients with AMI-RI, most clopidogrel users continued therapy, whereas many ticagrelor users switched during the 1-year follow-up. After propensity score adjustment, no statistically significant differences in ischemic or clinically significant bleeding outcomes were observed between the initial ticagrelor and clopidogrel strategies. These findings should be interpreted as inconclusive rather than indicative of equivalence.

OBJECTIVE:This study investigated whether educational attainment independently predicts long-term prognosis following acute coronary syndrome (ACS) and stroke, and whether this association is modified by acute-phase suicidal ideation (SI). METHODS:Data from two prospective cohorts (1,152 ACS; 396 stroke) were analyzed. Educational attainment (low ≤10 high vs. high >10 years) and SI were assessed approximately 2 weeks post-event. Primary endpoints-major adverse cardiac events (MACE) for ACS and cerebro-cardiovascular events (CCVE) for stroke-were ascertained over a 5-14 year follow-up. Hierarchical Cox models sequentially adjusted for vascular factors (Model 1), psychosocial/disease severity (Model 2), and combined covariates (Model 3). Sensitivity analyses used a ≥12-year education cutoff. RESULTS:Educational attainment was not an independent predictor of outcomes in either cohort across all models. However, a significant education×SI interaction emerged for MACE in the ACS cohort across all models (p=0.031-0.046). Among ACS patients with SI, higher education was associated with significantly reduced MACE risk (hazard ratio [HR]=0.54, 95% confidence interval 0.34-0.86, p=0.009), while no association existed without SI (HR=1.05, p=0.690). Similar interaction patterns in the stroke cohort achieved significance in Models 1 and 3, though stratified effects were attenuated, likely reflecting limited statistical power. Sensitivity analyses demonstrated directional consistency in both cohorts with some attenuation in fully adjusted models. CONCLUSION:Educational background modifies the prognostic impact of psychological distress in post-ACS patients. Lower-educated patients experiencing SI represent a high-risk subgroup requiring targeted psychosocial intervention. These findings support integrating educational status into psychosocial risk stratification protocols for acute cardiovascular care.

Objective:We aimed to investigate the efficacy and safety of a combination of fimasartan 30 mg and moderate-intensity statins in patients with hypertension and dyslipidemia in a real-world setting. Methods:This non-interventional, multicenter, prospective observational study included 5,264 patients receiving a combination of fimasartan 30 mg and moderate-intensity statins with 12-week follow-up data. Co-primary efficacy outcomes were the percentage of patients that achieved target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) control. Safety outcomes included adverse drug reactions and treatment-emergent adverse events. Results:At 12 weeks, the proportion of patients individually achieving target BP and LDL-C was 74.4% (95% confidence interval [CI], 73.2-75.5) and 85.6% (95% CI, 84.5-86.8), respectively. The proportion of patients achieving simultaneous control of target BP and LDL-C was 65.6% (95% CI, 64.1-67.2). The median (interquartile range; IQR) differences in systolic and diastolic BPs from baseline to 12 weeks were -8.0 mmHg (-19.0 to 0.0) and -4.0 mmHg (-11.0 to 0.0), respectively (both p-values <0.0001). The median (IQR) percentage change in LDL-C from baseline to 12 weeks was -11.5% (-33.5 to 4.8) (p<0.0001). No significant adverse drug reactions or serious treatment-emergent adverse events were reported during the study period. Conclusion:Findings of this study demonstrate that a combination of fimasartan 30 mg and moderate-intensity statins results in excellent control of BP and LDL-C levels without any safety issues.

Conventional drug-eluting stents suppress neointimal hyperplasia but delay re-endothelialization, raising long-term safety concerns. This study developed and evaluated a sirolimus–WKYMVm eluting stent (S-WES) to simultaneously promote re-endothelialization and suppress neointimal hyperplasia. Sirolimus-eluting stents (SES), WKYMVm-eluting stents (WES), and S-WES were fabricated using electrospray. Surface morphology was characterized via scanning electron microscopy (SEM), and in vitro drug-release kinetics were determined using high-performance liquid chromatography. Biological efficacy was assessed using human umbilical vein endothelial cell (HUVEC) and smooth muscle cell (SMC) assays. In vivo performance was evaluated over 4 weeks, followed by optical coherence tomography (OCT) and histopathological analysis. SEM analysis showed that S-WES had a uniform, crack-free polymer coating. Each stent was consistently loaded with sirolimus (105.15 ± 25.54 μg) and WKYMVm (1.07 ± 0.18 μg), yielding a dual drug-release profile. WKYMVm was almost completely released within 7 days, whereas sirolimus showed sustained release (day 1: 22.43 ± 5.32