Machine-learning based calculator for personalized risk assessment following ST-elevation myocardial infarction.

Background: Despite recent therapeutic advancements, a high-risk scenario for subsequent adverse events remains following ST-elevation myocardial infarction (STEMI). Risk scores provide important prognostication data following STEMI. However, the most established risk scores are not contemporary, their prognostic accuracy ranges across populations, and they cannot provide patient-centered recommendations.

Computed Tomography Angiography or Standard Care After Left Main PCI?

Background: The clinical benefit of routine coronary computed tomography angiography (CCTA) after percutaneous coronary intervention (PCI) for unprotected left main (LM) disease is uncertain.

Objectives: The authors evaluated whether CCTA-guided follow-up improves clinical outcomes vs symptoms- or ischemia-driven care after LM PCI.

Methods: PULSE was a prospective, multicenter, open-label randomized trial.

Adverse cardiovascular events in coronary Plaques not undeRgoing pErcutaneous coronary intervention evaluateD with optIcal Coherence Tomography. The PREDICT-AI risk model.

Introduction: Most acute coronary syndromes (ACS) originate from coronary plaques that are angiographically mild and not flow limiting. These lesions, often characterised by thin-cap fibroatheroma, large lipid cores and macrophage infiltration, are termed 'vulnerable plaques' and are associated with a heightened risk of future major adverse cardiovascular events (MACE). However, current imaging modalities lack robust predictive power, and treatment strategies for such plaques remain controversial.

Detection of subclinical atherosclerosis by image-based deep learning on chest X-ray.

Aims: To develop a deep-learning-based system for recognition of subclinical atherosclerosis on a plain frontal chest X-ray.

Methods And Results: A deep-learning algorithm to predict coronary artery calcium (CAC) score (the AI-CAC model) was developed on 460 chest X-ray (80% training cohort, 20% internal validation cohort) of primary prevention patients [58.4% male, median age 63 (51-74) years] with available paired chest X-ray and chest computed tomography (CT) indicated for any clinical reason and performed within 3 months.

External Validation of the PRECISE-DAPT Cancer Score in Patients With Acute Myocardial Infarction.

Aims: We aimed to externally validate the PRECISE-DAPT cancer score which showed better accuracy in predicting bleeding events in patients with cancer than the original PRECISE-DAPT score.

Methods: We used data from the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome) project. We compared the performance and clinical usefulness of the original score and the cancer score by calculating the C-statistic, the net reclassification index (NRI), and decision curve analysis.

Long-term clinical impact of sex disparities in patients with ST elevation acute myocardial infarction: a systematic review and meta-analysis of adjusted observational studies.

Objectives: We aimed to address an evidence gap by investigating the clinical impact of sex differences on long-term outcomes after primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction.

Design: Systematic review and meta-analysis.

Data Sources: Medline, Scopus and EMBASE were searched through August 2024.

Safety and efficacy of P2Y12 inhibitors in acute coronary syndromes patients with KDIGO stage IV-V renal disfunction not on dialysis: a subanalysis of the CORALYS registry.

Background: The impact of the most potent P2Y12i ticagrelor and prasugrel after acute coronary syndrome in patients with chronic kidney disease (CKD) remains unclear. Most evidence on dual antiplatelet therapy (DAPT) comes from real-world study but is limited to glomerular filtration rate (GFR) under 60 ml/min.

Methods: Consecutive patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and severe CKD defined as GFR under 30 ml/min not on dialysis from the CORALYS registry were included.

Association between lipoprotein(a) concentration and outcomes after percutaneous coronary intervention: A systematic review and meta-analysis.

Background: Lipoprotein(a) is well known to be associated with the development of cardiovascular disease. Patients with an elevated baseline lipoprotein(a) concentration may be prone to unfavourable clinical outcomes following percutaneous coronary intervention.

Aim: We performed a study-level meta-analysis to evaluate differences in clinical outcomes after percutaneous coronary intervention in patients with high and low serum lipoprotein(a) concentrations.

Duration of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention for bifurcation lesions: Insights from the ULTRA-BIFURCAT registry.

Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains debated, particularly for bifurcation lesions, which are associated with increased thrombotic risk. Shorter DAPT regimens may reduce bleeding but could compromise ischemic protection.

Methods: This study analyzed data from the ULTRA and BIFURCAT registries, including patients treated with PCI for bifurcation lesions.

One-Year Prognostic Differences and Management Strategies between ST-Elevation and Non-ST-Elevation Myocardial Infarction: Insights from the PRAISE Registry.

Introduction: Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.

Methods: Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI.

Machine-learning phenotyping of patients with functional mitral regurgitation undergoing transcatheter edge-to-edge repair: the MITRA-AI study.

Aims: Severe functional mitral regurgitation (FMR) may benefit from mitral transcatheter edge-to-edge repair (TEER), but selection of patients remains to be optimized.

Objectives: The aim of this study was to use machine-learning (ML) approaches to uncover concealed connections between clinical, echocardiographic, and haemodynamic data associated with patients' outcomes.

Methods And Results: Consecutive patients undergoing TEER from 2009 to 2020 were included in the MITRA-AI registry.

Echo and Hemodynamic-Guided Ramp Test in a Left Ventricular Assist Device Carrier With Right Ventricular Failure and Aortic Regurgitation.

The clinical outcomes of patients with left ventricular assist devices (LVAD) have steadily improved, unveiling late right ventricular failure (RVF) and aortic regurgitation (AR) as drivers of long-term mortality. The continuous-flow LVAD physiology and the patient's pre-existing features predispose to these complications, recently labeled hemodynamic-related events (HDREs). We present the case of an LVAD carrier complicated by both late RVF and AR, in which a comprehensive hemodynamic and echo-guided ramp test was carried out.

Hemoglobin-to-Creatinine Ratio Predicts One-Year Adverse Clinical Outcomes in ST-Elevation Myocardial Infarction: Retrospective and Propensity Score Matched Analysis.

: Anemia and renal impairment are key predictors of adverse outcomes in acute coronary syndromes (ACSs). The hemoglobin-to-creatinine (Hb/Cr) ratio combines these parameters into a simple index. This study aimed to evaluate its prognostic value at discharge in patients with ST-elevation myocardial infarction (STEMI).

Lipoprotein(a) in youth and childhood as a marker of cardiovascular risk stratification: a meta-analysis.

Background And Aims: Lipoprotein(a) [Lp(a)] is recognized as a risk factor for atherosclerotic cardiovascular diseases (ASCVD), yet its impact during childhood and youth remains understudied. This study aims to evaluate the role of Lp(a) as an independent risk factor for premature ASCVD among young patients.

Methods: PubMed, Scopus, and CINAHL Complete databases were systematically searched from inception to 12 December 2023 for adjusted observational studies examining the impact of Lp(a) in young patients.

Afterload mismatch after transcatheter edge-to-edge repair in functional mitral regurgitation: A propensity-score matched analysis.

Background: Transcatheter edge-to-edge repair (TEER) for severe functional mitral regurgitation (FMR) in patients with reduced left ventricular ejection fraction (LVEF) may lead to an acute increase in left ventricular afterload, termed afterload mismatch (AM). This study aimed to redefine AM clinically, analyse its determinants, and assess its prognostic impact post-TEER in FMR patients.

Methods: A multicenter case-control study was conducted, involving FMR patients with LVEF ≤35% undergoing TEER.

Final kissing balloon dilatation in patients with coronary bifurcation lesions treated with an upfront provisional stenting strategy.

Background: The impact of final kissing balloon inflation (FKB) in patients treated with an upfront provisional strategy for coronary bifurcation lesions is controversial.

Aims: We aimed to assess the impact of FKB on patient- and lesion-oriented outcomes in a large real-world cohort.

Methods: The ULTRA-BIFURCAT registry was obtained by patient-level merging the BIFURCAT and ULTRA registries.

Coronary CT angiography alone versus with CT perfusion: a systematic review and meta-analysis assessing approaches for chest pain.

Objectives: To evaluate the prognostic value of stress Computed Tomography Perfusion (CTP) in patients with suspected or known coronary artery disease.

Materials And Methods: All studies evaluating patients with chest pain with CTP plus coronary computed tomography angiography (CCTA) alone or versus CCTA were included. The primary analysis included studies comparing CCTA plus CTP vs CCTA alone, while in the secondary analysis we analyzed the incidence of each outcome across all seven studies, two- and single-arm.

Clinical impact of CCT-FFR as first-strategy in patients with symptomatic stable coronary artery disease: A systematic review and meta-analysis.

Aims: Despite the promising results, the clinical implications of the CCT-FFR is already debated. This metanalysis aimed to determine the potential benefits of incorporating FFRCT into stable CAD management.

Methods: After searching for studies comparing outcomes of patients with suspected stable CAD who underwent CCT-FFR as a first strategy versus non-urgent cardiovascular testing after a clinical judgment, we calculated odds ratios (ORs) and 95 ​% confidence intervals (CIs) using a random-effects or fixed-effects meta-analysis model depending on heterogeneity significance.

Feasibility of coronary access after transcatheter aortic valve implantation (TAVI): a systematic review and meta-analysis of observational studies.

Introduction: The expanding indications for transcatheter aortic valve implantation (TAVI) to younger, lower-risk patients, entails assessing not only the short-term clinical outcomes but also the long-term considerations for future interventions. The prevalence of coronary artery disease in TAVI patients is relevant, and the optimal timing of percutaneous coronary intervention remains a question.

Methods And Results: We conducted a systematic literature review and meta-analysis including 20 eligible studies involving 1660 patients who underwent coronary angiography after TAVI.

Impact of In-Hospital Bleeding on Postdischarge Therapies and Prognosis in Acute Coronary Syndromes.

Acute coronary syndromes (ACS) continue to pose significant challenges for clinical practitioners, particularly regarding the prediction of mid- to long-term outcomes. This study aims to investigate the impact of in-hospital bleeding (IHB) at 1-year follow-up in patients admitted for ACS. Data from 23,270 patients enrolled in the international PRAISE registry and discharged after ACS were analyzed.

Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non-Left Main Location and Treatment Strategy.

Background: Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non-LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current-generation drug-eluting stent era.

Methods: The ULTRA-BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation-dedicated registries from Korea and Italy.

Anatomic vs. Ischemia-Driven Strategies for Percutaneous Coronary Revascularization in Chronic Coronary Syndrome: A Network Meta-Analysis.

Introduction: In patients with chronic coronary syndromes (CCS), the benefit of percutaneous coronary intervention (PCI) added to optimal medical therapy (OMT) remains unclear. The indication to PCI may be driven either by angiographic evaluation or ischemia assessment, thus depicting different potential strategies which have not yet been thoroughly compared.

Methods: Randomized controlled trials (RCTs) comparing OMT versus PCI angio-guided or versus PCI non-invasive or invasive ischemia guided were identified and compared via network meta-analysis.

Diagnostic accuracy of late iodine enhancement on cardiac CT for myocardial tissue characterization: a systematic review and meta-analysis.

Purpose: to evaluate the diagnostic accuracy of late iodine enhancement (LIE) in cardiac computed tomography (CCT) compared to late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) for myocardial tissue characterization.

Materials And Methods: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting the accuracy of LIE with LGE as the gold standard of reference. QUADAS-2 tool was used to assess the risk of bias.

Assessing diagnostic accuracy of intravascular imaging for functionally significant coronary stenosis: updated findings from a meta-analysis.

Background: Accurate discrimination of functionally significant coronary stenosis using intravascular imaging remains uncertain, particularly with regard to vessel size. This meta-analysis evaluates the diagnostic performance of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for identifying functionally significant coronary stenosis as confirmed by fractional flow reserve (FFR).

Methods: A systematic search of PubMed, Scopus and Google Scholar identified studies that assessed the diagnostic accuracy of IVUS and OCT by minimal luminal area (MLA) with FFR as the reference standard.