Coronary Artery Disease and Atherosclerosis in Other Vascular Districts: Epidemiology, Risk Factors and Atherosclerotic Plaque Features.

Coronary artery disease (CAD) is the main cause of morbidity and death worldwide, and atherosclerosis represents the leading pathophysiological pathway responsible for CAD. Atherosclerotic process is a complex interplay of mechanisms and mediators resulting in plaque formation, progression and destabilization, the latter being the most frequent cause of acute cardiovascular events. Considering the systemic nature of atherosclerosis, polyvascular disease involvement is possible and has been described since 1960s.

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.

From Vision to Illumination: The Promethean Journey of Optical Coherence Tomography in Cardiology.

Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize atherosclerotic plaques was demonstrated in an in vitro study, and the following year marked the acquisition of the first in vivo OCT image of a human coronary artery.

Plaque Vulnerability and Cardiovascular Risk Factor Burden in Acute Coronary Syndrome: An Optical Coherence Tomography Analysis.

Background: Cardiovascular risk factors are strongly associated with adverse clinical outcomes, including acute coronary syndrome (ACS). Although individual risk factors have been related to specific plaque phenotypes, the relationship between the cumulative number of risk factors and plaque vulnerability has not been systematically explored.

Objectives: The purpose of this study was to investigate the association between the number of cardiovascular risk factors and plaque vulnerability defined by optical coherence tomography.

Antiplatelet Therapy in Myocardial Bridge: Insights From the RIALTO Registry.

Background: Myocardial bridge (MB) is a frequent coronary artery anomaly. The aims of this study are to describe the use of antiplatelet therapy (APT) in a cohort of patients with MB and assess its impact on ischemic and bleeding events.

Methods: The RIALTO (Myocardial Bridge Evaluation Towards Personalized Medicine) registry (ID: NCT05111418) is an ambispective multicenter observational registry, enrolling patients with a clinical indication to coronary angiography and evidence of MB.

Long-Term Prognostic Impact of OCT-Derived High-Risk Plaque Features: Extended Follow-Up of the CLIMA Study.

Background: The long-term prognostic impact of presumed high-risk morphologic plaque features detected by intracoronary optical coherence tomographic (OCT) imaging remains largely unknown.

Objectives: The aim of this study was to assess the relationship between OCT plaque characteristics and cardiovascular outcomes throughout 5 years as part of the CLIMA (Relationship Between OCT Coronary Plaque Morphology and Clinical Outcome) study.

Methods: In the multicenter, international, prospective CLIMA study, 1,003 patients underwent OCT evaluation of the untreated proximal left anterior descending coronary artery.

The role of percutaneous coronary intervention in spontaneous coronary artery dissection: between Scylla and Charybdis.

Spontaneous coronary artery dissection (SCAD) is a distinct and increasingly recognized cause of acute coronary syndromes, primarily affecting young and middle-aged women with few cardiovascular risk factors. While SCAD often resolves spontaneously with conservative management, percutaneous coronary intervention (PCI) is sometimes necessary, especially in patients with ongoing ischemia or high-risk anatomical features. This review summarizes the current state of knowledge regarding the interventional approach in SCAD, emphasizing the rationale for conservative treatment, and the indications for and challenges associated with PCI.

Vulnerable or High-Risk Plaque: A JACC: Cardiovascular Imaging Position Statement.

The concept of high-risk plaque emerged from pathologic and epidemiologic studies 3 decades ago that demonstrated plaque rupture with thrombosis as the predominant mechanism of acute coronary syndrome and sudden cardiac death. Thin-cap fibroatheroma, a plaque with a large lipidic core covered by a thin fibrous cap, is the prototype of the rupture-prone plaque and has been traditionally defined as "vulnerable plaque." Although knowledge on the pathophysiology of plaque instability continues to grow, the risk profile of our patients has shifted and the character of atherosclerotic disease has evolved, partly because of widespread use of lipid-lowering therapies and other preventive measures.

Characterization of ischemic etiology in heart failure with reduced ejection fraction randomized clinical trials: A systematic review and meta-analysis.

Aims: We investigated how ischemic etiology has been assigned in heart failure with a reduced ejection fraction (HFrEF) randomized controlled trials (RCTs).

Methods And Results: We performed a systematic review and meta-analysis of definitions, rates of ischemic etiology and of each ischemic definition component: i) coronary artery disease (CAD), ii) myocardial infarction (MI), iii) coronary revascularization, and iv) prior/current angina. A total of 145 HFrEF RCTs were selected, of which 133 (91.

Carotid artery atherosclerosis: mechanisms of instability and clinical implications.

Cardiovascular disease remains a prominent cause of disability and premature death worldwide. Within this spectrum, carotid artery atherosclerosis is a complex and multifaceted condition, and a prominent precursor of acute ischaemic stroke and other cardiovascular events. The intricate interplay among inflammation, oxidative stress, endothelial dysfunction, lipid metabolism, and immune responses participates in the development of lesions, leading to luminal stenosis and potential plaque instability.

Relationship Between Coronary Artery Calcium Score and Vulnerability of Culprit Plaque Assessed by OCT in Patients With Established Coronary Artery Disease.

Background: Coronary artery calcium score (CACS) is widely used for risk stratification. However, in patients with established coronary artery disease, its clinical implication and relationship with plaque vulnerability are unclear. We sought to correlate the CACS and plaque vulnerability assessed by optical coherence tomography.