Coronary artery disease最新文献

{"title":"Long-term clinical outcomes of revascularization compared with medical treatment in chronic total occlusion patients with reduced left ventricular ejection fractions.","authors":"HyeYon Yu, Jihun Ahn, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Soohyung Park, Cheol Ung Choi","doi":"10.1097/MCA.0000000000001610","DOIUrl":"10.1097/MCA.0000000000001610","url":null,"abstract":"<p><strong>Background: </strong>The benefits of revascularization in patients with chronic total occlusion (CTO) and reduced left ventricular ejection fraction (LVEF) remain controversial.</p><p><strong>Purpose: </strong>This study aimed to investigate the clinical impact of CTO revascularization in patients with reduced LVEF compared with those receiving medical treatment (MT).</p><p><strong>Methods: </strong>In total, 369 consecutive patients diagnosed with CTO by coronary angiography were allocated to either the MT group ( n  = 204) or the percutaneous coronary intervention (PCI, n  = 165) group according to the treatment strategy. The 5-year clinical outcomes were compared between the two groups using a Cox proportional hazards model.</p><p><strong>Results: </strong>After inverse probability treatment weighting analysis, the pseudo-sample sizes in the MT and PCI groups were 364 and 370, respectively. After a median 6-year follow-up period (interquartile range, 5.0-8.1 years), the incidence of cardiac death was higher in the MT and PCI groups, at 9.0 and 4.5%, respectively ( P  = 0.019). Cardiac death following heart failure hospitalization occurred in 3.8 and 1.0%, respectively ( P  = 0.017). In contrast, target vessel revascularization for CTO lesions was more frequent in the PCI group than in the MT group (11.5 and 22.7%, respectively, P  < 0.001). In the inverse probability treatment weighting population, patients undergoing CTO revascularization had survival benefits for cardiac death [hazard ratio: 0.48 (95% CI, 0.26-0.88)] and cardiac death after heart failure hospitalization [hazard ratio: 0.27 (95% CI, 0.08-0.84)].</p><p><strong>Conclusion: </strong>In patients with LV systolic dysfunction, particularly those with EF less than or equal to 40%, successful CTO revascularization is associated with long-term survival benefits. These results suggest that successful CTO revascularization is associated with reduced rates of cardiac death and death after hospitalization for heart failure.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":"344-354"},"PeriodicalIF":2.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracoronary supersaturated oxygen therapy after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: a systematic review and meta-analysis.","authors":"Alaa Abdrabou Abouelmagd, Ahmed Nazmy, Mazen Negmeldin Yassin, Abdelrahman A Elareef, Mohamed Esam Shalaan, Ahmed Abdelaziz, Islam Y Elgendy, C Michael Gibson, Mamas A Mamas, Patrick W Serruys, Gregg W Stone","doi":"10.1097/MCA.0000000000001663","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001663","url":null,"abstract":"<p><strong>Background: </strong>Supersaturated oxygen (SSO2) is a novel adjunctive treatment aims to reduce reperfusion injury after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). We conducted this study to evaluate the efficacy and safety of SSO2 therapy in patients with STEMI.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched Cochrane Central, Embase, PubMed, Scopus, and Web of Science for studies comparing SSO2 therapy post-PCI with PCI alone in adults with STEMI. Primary efficacy outcomes were infarct size and all-cause death. A random-effects model was used for analysis.</p><p><strong>Results: </strong>Six unique studies that enrolled 1591 patients were included [518 (32.5%) of whom received SSO2]. SSO2 therapy was associated with a reduction in infarct size compared with the control group [mean difference = -4.7% of left ventricular mass, 95% confidence interval (CI): -8.3 to -1.1%; P = 0.01], with the greatest benefit observed in patients reperfused within 6 h of symptom onset (mean difference = -6.0% of left ventricular mass, 95% CI: -8.9 to -3.0%). SSO2 therapy was also associated with reduced left ventricular end-systolic volume (mean difference = -19.9 ml, 95% CI: -33.7 to -6.2). The between-group difference in all-cause mortality was NS (P = 0.58); however, an association between SSO2 use and reduced all-cause death was present in the two studies with long-term (1-year) follow-up (risk ratio = 0.10, 95% CI: 0.01-0.77). No safety concerns were identified.</p><p><strong>Conclusion: </strong>SSO2 administration in patients with STEMI after primary PCI was safe and was associated with reduced infarct size, particularly when administered within 6 h of symptom onset. This myocardial salvage was associated with improvement in left ventricular function Further randomized trials are needed to definitively establish the impact of SSO2 on mortality and heart failure.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous right coronary artery chronic total occlusion recanalization after intravascular ultrasound-documented intramural hematoma.","authors":"Byeng-Ju Son, Hong-Ju Kim, Jun-Chang Jeong, Sun-Oh Kim","doi":"10.1097/MCA.0000000000001662","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001662","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of multivessel disease in patients with ST-segment elevation myocardial infarction: questioning routine immediate complete revascularization in all patients.","authors":"Tim Heller, Peter Ong, Udo Sechtem, Raffi Bekeredjian","doi":"10.1097/MCA.0000000000001661","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001661","url":null,"abstract":"<p><p>Primary percutaneous coronary intervention (PCI) of the culprit lesion is the preferred treatment in ST-segment elevation myocardial infarction (STEMI). However, in nearly half of all patients, multivessel coronary artery disease is present, raising fundamental questions: should non-culprit lesions be treated at all, and if so, should revascularization be performed immediately or in a staged fashion? Furthermore, should lesion selection be guided by angiography or by functional and imaging-based assessment? Over the past decade, landmark trials shifted clinical practice and formed the basis for current guideline recommendations of the European Society of Cardiology, advocating routine complete revascularization within 45 days in all hemodynamically stable patients. Yet, recently published evidence has challenged this paradigm. New randomized trials exploring the timing and guidance of non-culprit lesion PCI have yielded heterogeneous and, at times, conflicting results. While some suggest that immediate complete revascularization is safe, others raise concerns in patients with impaired cardiac function. Another recently published trial introduces a novel concept by directly comparing immediate physiology-guided PCI with a staged, noninvasive ischemia-guided strategy, demonstrating similar long-term outcomes with substantially fewer interventions. Together, these findings are reshaping the current view of the management of multivessel disease in STEMI. The metaphoric 'therapeutic pendulum' - after swinging firmly towards immediate complete revascularization - is beginning to swing back towards a more individualized, physiology- and imaging-based approach. The central aim of this review is to evaluate whether this individualized staged physiology- and imaging-based approach is a valid alternative to immediate complete revascularization. Clarifying which patients truly benefit from immediate complete revascularization remains a pivotal challenge for future clinical research and guideline development.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences of clinical outcomes in patients undergoing percutaneous coronary intervention: a nationwide cohort study.","authors":"Hack-Lyoung Kim, Yoonjong Bae, Mina Kim, Haechan Cho, Hyun Sung Joh, Woo-Hyun Lim, Jae-Bin Seo, Sang-Hyun Kim, Myung-A Kim","doi":"10.1097/MCA.0000000000001660","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001660","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in outcomes after percutaneous coronary intervention (PCI) remain debated, and evidence from large Asian populations is limited.</p><p><strong>Methods: </strong>We analyzed 136 109 patients (101 301 men; 34 808 women) without prior major cardiovascular events who underwent PCI between 2004 and 2020, using data from the Korean National Health Insurance Service. Baseline characteristics, in-hospital events, and long-term clinical outcomes were compared. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, nonfatal myocardial infarction, repeat PCI, coronary artery bypass surgery, and ischemic stroke.</p><p><strong>Results: </strong>Women were older and had higher rates of hypertension and diabetes, whereas men had higher smoking and alcohol consumption rates. In-hospital adverse events, including death, ischemic stroke, and bleeding were more frequent in women (P < 0.001). However, during a mean follow-up of 3.1 years, women had a lower incidence of MACE compared to men (58.0 vs. 65.3%; P < 0.001). Multivariable Cox regression confirmed that female sex was independently associated with a lower long-term risk of MACE (adjusted hazard ratio: 0.69-0.82, P < 0.001).</p><p><strong>Conclusion: </strong>Despite worse in-hospital outcomes, women had a more favorable long-term prognosis after PCI compared to men. These findings emphasize the importance of sex-specific approaches in risk assessment and long-term management after PCI.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of Orsiro, Xience, Synergy, and Resolute stent in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a nationwide registry study.","authors":"Hyun Woong Park, Yong Kyun Kim, Seok-Woo Seong, Jae-Hwan Lee, Mi Joo Kim, Pil Sang Song, Seon-Ah Jin, Kye Taek Ahn, Youngkeun Ahn, Sang Hyun Park, Jin-Yong Hwang, Chang-Hwan Yoon, Jin-Ok Jeong","doi":"10.1097/MCA.0000000000001659","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001659","url":null,"abstract":"<p><strong>Background: </strong>Head-to-head comparisons of contemporary drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) remain limited. We sought to compare the long-term clinical outcomes of four widely used DES platforms: Orsiro, Xience, Synergy, and Resolute.</p><p><strong>Methods: </strong>From the nationwide prospective Korea acute myocardial infarction registry-V, we identified 9284 patients with AMI undergoing percutaneous coronary intervention with one of the four study devices (Orsiro, n = 1634; Xience, n = 2576; Synergy, n = 2811; Resolute, n = 2263). The primary endpoint was target lesion revascularization (TLR). Inverse probability of treatment weighting was performed to adjust for baseline differences.</p><p><strong>Results: </strong>During a median follow-up of 723 days, the cumulative incidence of TLR differed significantly among groups. In IPTW-adjusted analyses, compared with the Orsiro group (reference), the risk of TLR was significantly higher in the Synergy [hazard ratio: 2.30; 95% confidence interval (CI): 1.20-4.41, P = 0.013] and Resolute groups (hazard ratio: 2.30, 95% CI: 1.18-4.47, P = 0.014). The Xience group showed a comparable risk of TLR to Orsiro (hazard ratio: 1.40, 95% CI: 0.69-2.82, P = 0.346). Target vessel revascularization followed a similar pattern, favoring Orsiro. However, there were no significant differences in composite major adverse cardiovascular events or all-cause mortality among the four groups.</p><p><strong>Conclusion: </strong>In this large-scale, real-world AMI cohort, the ultrathin-strut, biodegradable-polymer Orsiro stent was associated with a lower risk of repeat revascularization compared with the Synergy and Resolute stents. Xience demonstrated comparable outcomes to Orsiro. Stent selection remains a crucial determinant of vessel-level outcomes in patients with AMI.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Close separate origin of the left anterior descending and circumflex coronary arteries with a coexisting aorta-right atrial tunnel.","authors":"Arun Sharma, Mansi Verma, Manphool Singhal","doi":"10.1097/MCA.0000000000001658","DOIUrl":"10.1097/MCA.0000000000001658","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous repair following massive perforation of the right coronary artery with stent deployment toward the pericardium.","authors":"Cyrine Sghaier, Sonia Sghaier, Pierre-Emmanuel Massart, Georgiana Pintea Bentea","doi":"10.1097/MCA.0000000000001655","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001655","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De-escalation from prasugrel to clopidogrel at the 12-month landmark after percutaneous coronary intervention with drug-eluting stents for acute myocardial infarction: a Korea Acute Myocardial Infarction Registry-National Institutes of Health cohort study.","authors":"Byoung Geol Choi, Ji-Yeon Hong, Seung-Woon Rha, Seung Uk Lee, Myung Ho Jeong, Dong Joo Oh","doi":"10.1097/MCA.0000000000001657","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001657","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend 12 months of potent P2Y12 inhibitor-based dual antiplatelet therapy after acute myocardial infarction-drug-eluting stents (AMI-DES) percutaneous coronary intervention, but the optimal strategy beyond 1 year remains unclear. We evaluated the clinical impact of de-escalating from prasugrel to clopidogrel at the 12-month landmark.</p><p><strong>Methods: </strong>Using the nationwide Korea Acute Myocardial Infarction Registry-National Institutes of Health registry, we identified AMI patients who underwent successful percutaneous coronary intervention with DES and remained event free on aspirin-prasugrel (ASA/PSG) for 12 months. Patients were categorized into those who continued ASA/PSG or de-escalated to aspirin-clopidogrel (ASA/CPG). The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, or stroke during months 12-24. Propensity score matching was used to adjust for confounders.</p><p><strong>Results: </strong>Among 967 eligible patients, 384 continued ASA/PSG and 304 de-escalated to ASA/CPG. In the unmatched cohort, the cumulative incidence of the primary endpoint was lower in the ASA/CPG group (log-rank P = 0.045). In the propensity score matching cohort (250 pairs), there were no significant differences between the ASA/CPG and ASA/PSG groups for the primary endpoint (P = 0.316) or the secondary composite (P = 0.378). Absolute event rates were notably low in both groups; specifically, no definite/probable stent thrombosis or major bleeding occurred during the second year. Propensity score-adjusted Cox models confirmed these neutral findings (hazard ratio: 1.06, 95% confidence interval: 0.52-2.12).</p><p><strong>Conclusion: </strong>In stabilized AMI-DES survivors, de-escalating to clopidogrel at 12 months showed no significant difference in observed clinical outcomes compared with continued prasugrel, alongside a favorable safety profile. These findings suggest that clopidogrel-based de-escalation may be a reasonable step-down strategy in the second year, aligning with personalized therapy recommendations.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic anomalous aortic origin of the right coronary artery: multimodality imaging assessment and surgical treatment in two cases.","authors":"Koichi Nakamura, Ayane Kobayashi, Osamu Kurihara, Nobuaki Kobayashi, Yasuhiro Kawase, Kuniya Asai","doi":"10.1097/MCA.0000000000001654","DOIUrl":"https://doi.org/10.1097/MCA.0000000000001654","url":null,"abstract":"","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}