Background and purpose: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains challenging, with lower success rates compared to non-CTO procedures, particularly in the presence of calcified or fibrotic lesions. This study evaluates a novel intravascular piezoelectric wire system (IPWS) designed to facilitate guidewire advancement through these difficult CTO. Methods: We conducted a two-phase investigation: a preclinical feasibility and safety study in a porcine model, followed by a first-in-human clinical trial. The IPWS consists of a shockwave generator and a disposable guidewire that delivers high-amplitude mechanical pulses to facilitate penetration through calcified or fibrotic lesions. In the clinical phase, the system was used in 10 patients with CTO where standard antegrade wire escalation had failed. Results: In the preclinical study, the IPWS demonstrated excellent device compatibility with microcatheters and showed no significant vascular injury or thrombosis on histology. In the clinical trial, the IPWS achieved a 90% procedural success rate, successfully recanalizing nine of 10 CTO. No major adverse cardiac events (MACE) occurred during the 30-day follow-up. Mild complications, such as slow blood flow and marginal branch involvement, were transient and resolved without further intervention. Conclusions: The IPWS is a safe and feasible technology that may improve the success rate in complex CTO PCI. By facilitating wire passage through challenging lesions, the IPWS could reduce procedural complexity and risk. Further refinements are warranted, but this technology holds significant promise for advancing the treatment of CTO and other complex vascular interventions.

Poly-lactic acid (PLA) bioresorbable scaffolds provide temporary vascular support but trigger late-stage inflammation during polymer dissolution, frequently driving neointimal hyperplasia before complete dissolution. While acute biomaterial responses are well documented, the innate immune mechanisms dictating chronic vascular remodeling remain poorly defined. We demonstrate that late-stage PLA degradation actively instructs a microenvironment dominated by neutrophil extracellular trap (NET). Combining transcriptomic profiling of stented porcine arteries, and longitudinal spatial histology, we mapped a sustained immune response directly coupled to polymer breakdown. Mechanistically, PLA degradation products induce NET extrusion via mitochondrial calcium uniporter-mediated calcium overload. These extracellular structures subsequently function as potent paracrine signals, driving human vascular smooth muscle cells (VSMCs) toward a proliferative, synthetic phenotype. We identified a toll-like receptor 2 (TLR2) signaling pathway as the primary transducer of this NET-driven VSMC reprogramming. To apply these findings therapeutically, we engineered a customized PLA scaffold coated exclusively with the selective TLR2 inhibitor C29. In a rabbit iliac artery model, this targeted immunomodulatory device successfully disrupted the local inflammatory loop, significantly reducing neutrophil accumulation and mitigating neointimal hyperplasia. This study establishes the biomaterial-driven NET-TLR2 axis as a central mechanism of adverse vascular remodeling and offers a precise bioactive strategy to preserve long-term luminal patency.

This study assessed the feasibility and safety of ultrasound renal denervation (uRDN) targeting both main and branch renal arteries to treat uncontrolled hypertension. A circumferential uRDN system was evaluated in a porcine model (n = 6) and a first-in-human study (n = 5). Endpoints included the incidence of device-related adverse events and changes in blood pressure. Preclinical studies revealed a favorable safety profile and >97% reduction in renal norepinephrine levels. In the human study, all procedures were technically successful without device-related adverse events. At 2 and 6 months, 24-hour ambulatory systolic/diastolic blood pressure decreased by 8.8 (95% CI: 0.98-16.62)/4.6 (95% CI: -1.83 to 11.03) mm Hg and 16 (95% CI: 1.18-30.82)/8 (95% CI: 0.76-15.24) mm Hg , respectively. These preliminary findings support the feasibility and safety of this circumferential uRDN approach for uncontrolled hypertension. (A Prospective Feasibility Trial Investigating the Use of Hantong Medical uRDN System in Patients With Uncontrolled Hypertension (Hammer HTN; ChiCTR2400093088).

Background Accurate evaluation of coronary artery disease is critical for guiding treatment decisions, particularly in complex coronary lesions. Fractional flow reserve (FFR) remains the gold standard for assessing lesion-specific ischemia but is invasive and requires pharmacological hyperemia. Noninvasive alternatives, such as quantitative flow ratio (QFR) from coronary angiography and ultrasonic flow ratio (UFR) from intravascular ultrasound (IVUS), offer promising diagnostic approaches. Objectives This study aimed to compare the diagnostic performance of UFR and QFR against FFR in assessing complex coronary lesions. Methods This retrospective multicenter study included 217 patients (220 vessels) who underwent IVUS and FFR. UFR was derived from IVUS imaging, and QFR was calculated using coronary angiography data. Correlation, agreement, and diagnostic metrics (sensitivity, specificity) were analyzed, with receiver operating characteristic curves assessing accuracy. Results UFR demonstrated stronger correlation with FFR (r = 0.79; 95% CI: 0.74-0.84; P < 0.001) compared with QFR (r = 0.68; 95% CI: 0.60-0.74; P < 0.001). UFR also showed better diagnostic performance, with an area under the receiver operating characteristic curve of 0.91 (95% CI: 0.86-0.94) compared with QFR’s 0.86 (95% CI: 0.81-0.90). In complex lesions (diffuse, bifurcation, calcified), UFR consistently outperformed QFR, particularly in bifurcation and lesions heavily calcified, where QFR accuracy dropped significantly (72.5% vs 86.8%, P = 0.001). Conclusions In this retrospective hypothesis-generating study, UFR showed numerically higher diagnostic accuracy than QFR in complex coronary lesions. These findings suggest UFR may have potential as a complementary tool for functional assessment, but definitive conclusions about superiority require validation in larger prospective studies. (Comparison of UFR With QFR in Stable Coronary Artery Disease; NCT06322355)

BACKGROUND:Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease. As procedural volumes continue to rise, the associated radiation risk from angiography systems has drawn increasing concern. Thus, we developed a novel ultra-low-dose Noise-Free technology to optimize angiography systems. This study aims to investigate whether it effectively reduces radiation exposure in real-world coronary interventions. METHODS:A comparative study on a single-center, real-world, observational cohort. The primary end point was an intergroup comparison of procedural radiation exposure, including dose area product, air kerma, and dose rate, stratified by exposure mode (fluoroscopy or cine) and procedure type (diagnostic coronary angiography, single-vessel PCI, or chronic total occlusion PCI). The secondary end point included an expert semi-quantitative assessment and a quantitative contrast-to-noise ratio for image quality. RESULTS:A total of 380 procedures (102 coronary angiography, 78 single-vessel PCI, and 200 chronic total occlusion PCI) were performed in 380 patients using 4 different angiography systems. There was no significant difference in baseline patient characteristics, procedural time, or operator experience. In coronary angiography procedures, the ultra-low-dose technique demonstrated a total air kerma of 60.3 (38.5-74.1) mGy, total dose area product of 4.0 (2.9-5.2) Gy·cm2, fluoroscopy dose rate of 7.9 (6.0-9.6) mGy/min, and cine dose rate of 51.7 (37.4-64.9) mGy/min, corresponding to 40% to 70%, 37% to 66%, 16% to 62%, and 25% to 79% reductions than others, respectively. Similar radiation reductions were observed for single-vessel PCI. For chronic total occlusion PCI, the corresponding percentages of radiation reduction in total air kerma, total dose area product, fluoroscopy dose rate, and cine dose rate were 59% to 73%, 54% to 69%, 22% to 64%, and 60% to 79%, respectively, relative to the other 3 systems. The semi-quantitative assessment and contrast-to-noise ratio analysis showed comparable image quality between the 4 systems. CONCLUSIONS:The Noise-Free technique reduced radiation exposure across cumulative and rate metrics while preserving diagnostic image quality, with the greatest reduction observed in complex cases. These findings support its clinical utility for lowering radiation risk.

Incomplete stent expansion is an important mechanism leading to adverse events. However, few detailed OCT studies have compared the immediate performance of bioresorbable scaffolds (BRS) and drug-eluting stents (DES). The aim of this study was to compare the acute and short-term performance differences between polymeric BRS and metallic DES, and to explore the underlying mechanisms of immediate stent underexpansion and eccentricity reduction. Our study consecutively enrolled 298 patients who underwent optical coherence tomography (OCT) pullbacks after BRS or DES implantation, with 178 patients in the BRS group and 120 patients in the DES group. To reduce confounding, propensity score matching generated 64 balanced pairs of patients. The core laboratory used AI-driven virtual histology technology to measure immediate vascular and plaque parameters. Clinical follow-up was conducted for 1 year post-procedure, and major adverse cardiac events (MACE) were recorded. After propensity score matching, the BRS group had similar luminal and stent parameters to the DES group, with lower mean and minimum stent eccentricity indices (SEC). Furthermore, the BRS and DES groups had similar characteristics of fibrous plaque (FP) and calcific plaque (CP). More severe CP and FP restricted adequate expansion of BRS and DES. The incidence of 1-year MACE did not differ significantly between the BRS and DES groups (log-rank p = 0.685). The BRS appears to have comparable acute performance and reduced SEC when compared to DES. The stent expansion and eccentricity were associated with the characteristics of CP and FP. BRS and DES showed no significant difference at 1-year follow-up.

Cardiometabolic multimorbidity, encompassing type 2 diabetes, hypertension, and metabolic dysfunction-associated steatotic liver disease, is closely linked to sympathetic nervous system overactivity and remains suboptimally controlled by pharmacotherapy alone. This state-of-the-art review evaluates the biological rationale, technical feasibility, preclinical evidence, and emerging clinical data supporting combined hepatic and renal denervation as an investigational neuromodulatory strategy for cardiometabolic disease. Preclinical models suggest that multiorgan denervation may modulate sympathetic activity and metabolic pathways, whereas early first-in-human studies of celiac-hepatic denervation indicate feasibility and acceptable short-term safety. However, current human evidence remains limited by small sample sizes, single-arm designs, and the absence of sham-controlled trials, precluding definitive conclusions regarding efficacy, durability, and causal mechanisms. Combined hepatic-renal denervation should therefore be regarded as a translational-stage, hypothesis-generating approach. Rigorous randomized trials are required to define target engagement, safety, durability, and clinical relevance.

BACKGROUND:The drug delivery eï¬ciency of drug-coated balloons (DCBs) in de novo coronary artery disease is correlated with atherosclerotic plaque characteristics. It remains to be elucidated whether plaque composition and vulnerability can affect the efficacy of DCBs. AIMS:This study aimed to explore the association between a novel angiography-based radial wall strain (RWS) measurement for plaque vulnerability and DCB efficacy in de novo small vessel disease (SVD). METHODS:This study is a post hoc analysis of 266 SVD lesions in 260 patients treated with a paclitaxelâcoated balloon or plain old balloon angioplasty (POBA) from the PEPCAD China SVD study. The baseline maximum RWS (RWSmax) ≥13% was selected as the cutoff value for vulnerable plaques. The primary outcome was in-segment late lumen loss (LLL) at 9-month follow-up. RESULTS:A total of 152 and 72 lesions in the DCB and POBA groups, respectively, completed the 9-month angiographic follow-up. In the DCB group, lesions with RWSmax ≥13% had higher in-segment LLL (0.24±0.53 mm vs 0.05±0.16 mm; p=0.0009), greater binary restenosis (14.9% vs 1.9%; p=0.0040) and more target lesion failure (10.2% vs 1.6%; p=0.022) than those with RWSmax <13%. Among all the lesions with RWSmax ≥13%, no significant difference was observed in in-segment LLL (0.24±0.53 mm vs 0.32±0.48 mm; p=0.49) between the DCB and POBA groups. CONCLUSIONS:Angiographically derived RWS has the potential to predict the angiographic and clinical outcomes of DCB treatment for de novo SVD (PEPCAD China SVD study; ClinicalTrials.gov: NCT03625830).

BACKGROUND:Drug-coated balloons are emerging as an important approach for the treatment of coronary bifurcation lesions (CBL). AIMS:This study aimed to evaluate the efficacy and safety of a novel paclitaxel-coated balloon (PCB), which used propyl gallate (PG) as the excipient, in treating the side branch of de novo CBL. METHODS:In this multicenter, randomized, non-inferiority trial, 236 patients across 17 centers were 1:1 randomized to the PG-based PCB or iohexol-based PCB groups. After stent deployment in the main vessel, the side branch was dilated with the allocated PCB. Angiographic follow-up was planned at 9 months and clinical follow-up at 12 months. The primary endpoint was diameter stenosis (DS) in the side branch during the angiographic follow-up. RESULTS:DS in the side branch was 21.3 ± 23.8% in the PG group versus 21.7 ± 24.3% in the control group (p = 0.198). After adjustment for centers, the difference of DS between the PG group and the control group was -0.11% (95% confidence interval, -6.84% to 6.62%), meeting the prespecified non-inferiority margin of 7%. Clinical outcomes at 12 months were comparable between groups. CONCLUSIONS:The PG-based PCB demonstrated non-inferior efficacy and safety in comparison with the iohexol-based PCB for side branch treatment in de novo CBL. The PG-based PCB could be used as a therapeutic alternative in CBL revascularization.

Background and purpose:The functional assessment of myocardial bridge (MB) is challenging and still unsettled. The objective of this study is to evaluate the feasibility and diagnostic performance of quantitative flow ratio (QFR) computed during different cardiac phases in patients with MB, using wire-based fractional flow reserve (FFR) as the reference standard.Methods:Patients with MB who underwent both coronary angiographies and FFR measurement were retrospectively enrolled. Murray law-based QFR (mu QFR) of the MB artery was automatically calculated for the bridged artery using a single angiographic projection, empowered by artificial intelligence (AI) algorithms, in three different approaches: from systolic phase images (sys-mu QFR), diastolic phase images (dias-mu QFR), and from lumen deformation throughout the cardiac cycle at the milking segment (D-mu QFR).Results:A total of 118 vessels from 118 patients were analyzed. When compared with FFR using a cutoff value of 0.80 to define ischemia, diagnostic accuracy was 79% (95% confidence interval [95% CI]: 71%-86%) for sys-mu QFR, 86% (95% CI: 80%-93%) for dias-mu QFR, and 92% (95% CI: 86%-97%) for D-mu QFR. Sensitivities were 96% (95% CI: 81%-100%), 41% (95% CI: 22%-61%), and 67% (95% CI: 46%-84%), while specificities were 74% (95% CI: 63%-82%), 100% (95% CI: 96%-100%), and 99% (95% CI: 94%-100%) for sys-mu QFR, dias-mu QFR, and D-mu QFR, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.86 (95% CI: 0.79-0.92) for sys-mu QFR, 0.92 (95% CI: 0.86-0.96) for dias-mu QFR, and 0.94 (95% CI: 0.88-0.98) for D-mu QFR.Conclusions:AI-aided mu QFR enables rapid, wire-free functional assessment of MB. By quantifying lumen deformation dynamics across the cardiac cycle, D-mu QFR achieves optimal diagnostic accuracy. This technology may serve as a clinically viable wire-free alternative to invasive FFR for MB evaluation.

Background: Accurate assessment of coronary artery disease is essential for guiding clinical decision-making, particularly in cases involving complex coronary lesions. Fractional Flow Reserve (FFR) remains the reference standard for lesion-specific ischemia evaluation; however, it is invasive and requires pharmacologically induced hyperemia. Emerging non-invasive alternatives, including Quantitative Flow Ratio (QFR) derived from coronary angiography (CAG) and Ultrasonic Flow Ratio (UFR) derived from intravascular ultrasound (IVUS), offer promising diagnostic value. This study aimed to compare the diagnostic performance of UFR and QFR against FFR in the assessment of complex coronary lesions. Methods: In this retrospective, multicenter study, 217 patients (220 vessels) with coronary artery lesions who underwent both intravascular ultrasound (IVUS) and FFR measurement were included. UFR was derived from IVUS imaging, while QFR was computed using coronary angiography (CAG) data. Correlation coefficients, agreement analyses, and diagnostic metrics including sensitivity and specificity were employed to evaluate the performance of UFR and QFR against FFR, with receiver operating characteristic (ROC) curve analysis used to assess diagnostic accuracy. Results: UFR demonstrated a stronger correlation with FFR (r = 0.79, p < 0.001) compared to QFR (r = 0.68, p < 0.001). Moreover, UFR exhibited superior diagnostic performance, with an area under the ROC curve (AUC) of 0.91, exceeding that of QFR (AUC = 0.86). In subsets of complex lesions—specifically diffuse, bifurcation, and heavily calcified lesions—UFR consistently outperformed QFR, with the most pronounced difference observed in bifurcation and calcified lesions where QFR accuracy was significantly reduced (72.5% vs. 86.8%, p = 0.001). Conclusion: UFR provides enhanced diagnostic accuracy compared to QFR for complex coronary lesions and represents a reliable, non-invasive alternative to FFR, particularly in challenging anatomical scenarios such as bifurcation and heavily calcified lesions. The clinical integration of UFR may reduce the reliance on invasive FFR measurements while preserving diagnostic precision. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ClinicalTrials.gov ([NCT06322355][1]). ### Funding Statement This work was supported by grant from Shanghai Pujiang Program (No. 22PJD011 and 22PJD012). ### 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: he study received approval from the institutional review boards at Zhongshan Hospital in Shanghai, Shanghai 7th People's Hospital, and Zhengzhou 7th People's Hospital 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 Data will be made available on request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT06322355&atom=%2Fmedrxiv%2Fearly%2F2025%2F04%2F19%2F2025.04.16.25325975.atom

Backgrounds A coronary atherectomy system (CAS) was developed with a novel burr designed for a two-phase atherectomy procedure: low-speed drilling for lesion crossing and high-speed orbiting to achieve luminal gain, to removal the stenosis in artery. Aims To investigate the CAS mechanism and validate its efficacy and safety. Methods Engineering bench-top testings were conducted to evaluate the burr crossing time, luminal gain, debris size, temperature rise, and grinding force together with in-vivo and ex-vivo swine studies. Results The bench-top engineering testing results showed that the CAS can expand the calcified lumen diameter from 0.4 to 1.7 mm and the debris size, temperature rise, and grinding force were relatively low and safe. In the in-vivo swine study, the media and internal elastic membrane remained intact. The intima of the artery was removed at the 0-day follow-up and re-growthed at the 30-day follow-up. No abnormal phenomenon in the digital subtraction angiography, blood testing, ECG, and anatomy analysis were found. The ex-vivo study, by inserting a plaque surragate (graphite) into the coronary artery, showed similar efficacy in luminal gain and safety. Conclusions This study demonstrated the efficacy and safety of CAS device with the novel two-phase burr design.

BACKGROUND: There is a lack of intravascular imaging assessment and long-term clinical follow-up regarding side branch occlusion (SBO) after bioresorbable vascular scaffold (BVS) implantation. The aim of this study was to identify independent predictors of SBO after BVS implantation and characterize its short- and long-term outcomes. METHODS: This study enrolled 444 patients undergoing BVS implantation. Quantitative coronary angiography was performed to analyze 460 lesions and 1,094 side branches (SB), with independent predictors of SBO identified through generalized linear mixed models. Virtual histology technology based on optical coherence tomography was utilized to characterize main vessel plaque morphology. All enrolled patients completed clinical follow-up at 30 days and 2 years post-procedure. RESULTS: The incidence of BVS-SBO was 4.9% (54/1,094 SBs), with independent predictors including SB diameter < 1 mm (OR = 3.999, p < 0.001), SB ostial stenosis > 50% (OR = 6.244, p < 0.001), and SB location within the obstruction segment (OR = 8.668, p < 0.001). SBO lesions showed higher relative volumes of lipid plaque (29.5% vs. 22.9%, p = 0.028) and calcified plaque (2.7% vs. 1.1%, p = 0.027) compared with non-SBO lesions. The SBO group exhibited a markedly higher incidence of perioperative myocardial infarction (33.3% vs. 10.8%, p < 0.001), although there was no significant difference in 2-year major adverse cardiovascular events (5.6% vs. 4.1%, p = 0.629) between groups. CONCLUSION: SBO after BVS implantation is associated with SB anatomical characteristics and plaque features. While SBO increases the incidence of perioperative myocardial infarction, it does not elevate long-term clinical risk.

In-stent restenosis (ISR) remains a major stent failure post-PCI. This study aimed to explore the predictive capability of pre-PCI baseline angiographically-derived radial wall strain (RWS) for the development of ISR in self-controlled patients. In this retrospective self-controlled study, we included 64 patients (146 stented lesions) with multivessel PCI in whom at least one vessel developed ISR and at least one remained free of ISR, allowing within-patient comparison. Pre-PCI baseline RWS was measured for all stented lesions in each patient. Lesion-level maximal RWS (RWSmax) was defined as the highest RWS in the stenotic segment. The incremental discriminant and reclassification abilities for ISR prediction were compared between 2 models (Model 1: Angiography Characteristics + Stent Characteristics; Model 2: Model 1 + RWSmax). Among all lesions, 76 (52.1

BACKGROUND:Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury. METHODS:This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion which was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (five and 42 days post-MI) and a series of biomarkers/histological studies were performed. RESULTS:The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH. CONCLUSIONS:The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.

OBJECTIVES:The instantaneous wave-free ratio (iwFR) has limited availability. A new resting index called the constant-resistance ratio (cRR), which dynamically identifies cardiac intervals with constant and minimum resistance, has been developed; however, its diagnostic performance is unknown. The aim of this study was to validate the cRR by retrospectively calculating the cRR values from raw pressure waveforms of 2 publicly available datasets and compare them with those of the iwFR. METHODS:Waveform data from the CONTRAST and VERIFY 2 studies were used. The primary endpoint was Bland-Altman bias between cRR and iwFR. Secondary endpoints included diagnostic agreement, correlation, receiver operating characteristic (ROC) analysis, and success rates of cRR and iwFR. RESULTS:Among the 1036 waveforms, 871 were successful in determining paired cRR and iwFR values, while cRR was 6% more successful than iwFR (P less than .0001). The mean bias between cRR and iwFR was 0.003, with 95% limits of agreement [-0.021,0.028]. These 2 indices were highly correlated (r = 0.991; P less than .0001). Using an iwFR of 0.89 or less as the reference standard, the optimal cRR cutoff was 0.89, with an area under the ROC curve of 0.991 (P less than .001) and a diagnostic accuracy of 96.9% (95% CI [96%, 98%]). CONCLUSIONS:The cRR, a new resting index for identifying dynamic cardiac intervals with constant and minimum resistance, demonstrated high numerical agreement, diagnostic consistency, and a higher success rate than the iwFR based on the 2 publicly available datasets.

BACKGROUND The radial wall strain (RWS) is a novel angiography-based method to assess the biomechanical property of the coronary artery and whether it can predict future acute myocardial infarction (AMI) events remains to be elucidated.OBJECTIVES This study aimed to investigate the association between angiography-derived RWS and future AMI events in mild to intermediate lesions.METHODS We performed a matched case-control analysis nested in a retrospective cohort of patients who had received prior angiography (the index procedure) at least 1 month before and were hospitalized again for repeat angiography. Patients with at least 1 de novo mild to intermediate lesion identified at the index procedure and eligible for RWS analysis were enrolled. The study identified cases with target lesion-related AMI diagnosed at the repeat angiography, matching each case to 3 control subjects without AMI.RESULTS Altogether 44 patients with lesion-related AMI and 132 matched controls were enrolled. The median diameter stenosis of the overall interrogated lesions was 34.0%. The baseline maximum RWS (RWSmax), which was defined as the highest RWS in the stenotic segment, was significantly higher in lesions responsible for AMI than those that remained quiescent (median 13% vs 10%; P < 0.001). RWSmax was predictive of lesion-related AMI, with an area under the curve of 0.83 (95% CI: 0.76-0.90; P < 0.001) and an optimal cutoff >12%. RWSmax >12% was found to be independently associated with subsequent AMI events with a risk ratio of 7.25 (95% CI: 3.94-13.37; P < 0.001).CONCLUSIONS Among angiographically mild to intermediate lesions, a high-strain pattern identified by angiography-derived RWS was associated with an increased risk of AMI events. (J Am Coll Cardiol Intv 2023;16:1039-1049)& COPY; 2023 by the American College of Cardiology Foundation.

Chemotherapy is a critical treatment modality for cancer patients, but multidrug resistance remains one of the major challenges in cancer therapy, creating an urgent need for the development of novel potent chemical entities. Azoles, particularly pyrazole, could interact with different biological targets and exhibit diverse biological properties including anticancer activity. Many clinically used anticancer agents own an azole moiety, demonstrating that azoles are privileged and pivotal templates in the discovery of novel anticancer chemotherapeutics. The present article is an attempt to highlight the recent advances in pyrazole-azole hybrids with anticancer potential and discuss the structure-activity relationships, covering articles published from 2018 to present, to facilitate the rational design of more effective anticancer candidates.