Chronic kidney disease (CKD) is prevalent among patients with coronary artery disease (CAD) and exacerbates myocardial ischemia. However, the survival benefit of percutaneous coronary intervention (PCI) across different stages of CKD remains controversial. CAD patients ( = 17,418) with CKD (mean age, 69.5 ± 9.9 years; 70.9% male) were included in the Cardiorenal Improvement II cohort from 2007 to 2020. Patients were grouped by PCI or medical treatment and further categorized by stages 3a-5 CKD. Multivariable Cox regression was performed to investigate the associations of cardiovascular- and all-cause mortality with PCI and CKD stage, and to compare predictors of outcomes in patients stratified by advanced CKD. During a median follow-up of 4.2 years, 4605 (26.4%) participants died. Compared with medical treatment, PCI was not associated with improved survival benefit among patients with stage 3b-5 CKD (all  > .05). Among patients with advanced CKD, hypertension, hyperfibrinogenemia and moderate-severe malnutrition were more significantly associated with increased cardiovascular mortality with relatively high attributable risk. PCI was not associated with a survival advantage among patients with advanced CKD. Hypertension, hyperfibrinogenemia and malnutrition may contribute to poor prognosis in patients with advanced kidney disease.

Patients with chronic-limb threatening ischemia (CLTI) and peripheral wounds might be predisposed for systemic infections. The study aimed to describe the rate of systemic infections in patients with CLTI compared with peripheral artery obstructive disease (PAOD) patients without CLTI, both independently of endovascular treatment (EVT) and after EVT. Administrative data of the AOK Baden-Wuerttemberg (AOK BW) from patients with PAOD were analyzed considering bloodstream infection (BSI), 30-day readmission and prescribed antibiotics for ischemic ulcers. The risk of BSI increased 3.9-fold (95% CI: 3.4-4.4) in patients with PAOD Rutherford-Becker category (RBC) 5 and 6 ( = 11,741) compared with PAOD RBC 1-4 ( = 23,482; 6.81% vs 1.67%,  < .01). The risk of BSI increased 5.6-fold (95% CI: 4.1-7.7) comparing RBC 5 and 6 (1.2%) with RBC 1-4 (0.22%,  < .01). Outpatient antibiotic prescriptions were dominated by aminopenicillins with β-lactamase inhibitors, accounting for 34.9%. Clindamycin, cefuroxime, and fluoroquinolones represented 14.9%, 13.5%, and 12.6% of prescriptions, respectively. Infections were responsible for 7.7% of 30-day readmissions following EVT. Patients with CLTI are at risk of developing BSI, and specifically BSI. Infection-related causes in 30-day readmissions following EVT are common. The high use of clindamycin and cefuroxime in outpatients is concerning.

Acute coronary syndromes (ACS) are one of the most common causes of morbidity and mortality worldwide. Primary percutaneous coronary intervention (pPCI) is the main treatment strategy to restore myocardial perfusion. However, the no-reflow phenomenon (NRP) may block coronary flow. The present study focused on assessing and contrasting predictive parameters for NRP in ACS patients. Our research is a retrospective analysis. We assessed the parameters significantly associated with NRP using Cox regression and Receiver operating characteristic (ROC) Curve analysis. The study included 5122 patients who met the criteria. The average age of the patients was 63.9 + 13.2, and 74.4% were male. It was observed that NRP developed in 1.8% of all patients. Age, hemoglobin (Hb), white blood cell (WBC), glucose and low density lipoprotein cholesterol (LDL-C) were determined to be independent predictors of NRP. The power of these parameters to predict NRP was similar, and WBC was the most predictive (Area Under Curve (AUC): 0.605 95% CI: 0.539-0.671,  = .001). We believe that the use of these simple, practical, and routinely used hematological and biochemical parameters will help us predict the risk of developing NRP before pPCI. This information should improve management.

The left internal mammary (thoracic) artery (LIMA), when used as a pedicle graft at the time of coronary artery bypass grafting, is effective and durable. Data concerning the rate and causes of LIMA failure are scant. The aim of this paper is to explore the modes and frequency of sub-optimal LIMA grafts. We examined all cases of invasive graft angiography performed in our cardiothoracic center 2016-2020 and analyzed the quality of the LIMA graft. Of 551 cases, 323 had undergone isolated coronary artery bypass grafting including a LIMA since 2001; of those, 59 (18%) appeared sub-optimal; 16 (5%) being totally occluded, 26 (8%) exhibiting a "string sign" (i.e., atretic or cord-like), 12 (4%) being focally stenosed, and 5 (1.5%) being patent but placed on a diseased portion of the left anterior descending artery or other vessel. The commonest cause of failure were poor-quality left anterior descending artery target and non-flow-limiting disease. This paper highlights the low rate, and likely modes, of failure of this valuable treatment in contemporary practice.

Silent new ipsilateral ischemic lesions (sNIIL) detected by diffusion-weighted imaging (DWI) are commonly observed after carotid artery stenting (CAS). We aimed to analyze the association of carotid plaque characteristics on Virtual Histology Intravascular Ultrasound (VH-IVUS) with sNIIL, which is not well understood. Among 128 patients who underwent CAS and VH-IVUS, 112 patients who underwent DWI within 72 h after CAS were included for analysis. VH-IVUS detected cross-sectional composition of plaques including necrotic core (NC), dense calcium (DC), fibrous (FI), and fibrofatty (FF) in each frame. Plaques with ≥3 consecutive thin-cap fibroatheroma (TCFA) or calcified thin-cap fibroatheroma (CaTCFA) frames were defined as vulnerable. Logistic regression was applied to evaluate the association between plaque characteristics and sNIIL. A total of 56 patients (50%) had sNIIL. Larger NC in the maximum NC frame (odds ratio [OR] = 1.35; 95% confidence interval [CI]: 1.03-1.75;  = .029) and defined vulnerable plaques (OR = 3.89; 95% CI: 1.68-9.01;  = .001) were associated with sNIIL. Incidence of sNIIL showed an escalating trend with the increase of quartiles of NC ( = .010). The findings of this study suggest that composition and distribution characteristics of carotid plaques on VH-IVUS during CAS have potential clinical significance.

Lipid ratio is a balance between atherogenesis and antiatherogenesis. it is an important predictive marker of carotid plaque. The lipid ratios, which include non-high-density lipoprotein cholesterol (non-HDL-C)/high-density lipoprotein cholesterol (HDL-C), remnant cholesterol (RC)/HDL-C, apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1), low-density lipoprotein cholesterol (LDL-C)/HDL-C, ApoB/HDL-C, total cholesterol (TC)/HDL-C, triglycerides (TG)/HDL-C, were included and analyzed. Sex differences in the relationship between lipid ratios and carotid plaque were discussed. The risk of carotid plaque was found to be significantly associated with the Non-HDL-C /HDL-C, RC/HDL-C, ApoB/ApoA1, LDL-C /HDL-C, ApoB/HDL-C, TC/HDL-C in females but not in males. The ApoB/HDL risk presented the highest relationship with carotid plaque in females only. The predictive value of the aforementioned lipid ratios for carotid plaque was observed in females only.

Obesity and pre-diabetes are metabolic disorders associated with insulin resistance (IR). Excess epicardial adipose tissue is also associated with increased IR. The triglyceride-glucose index (TyG) has been evaluated as an alternative measure of the IR in a variety of metabolic and cardiovascular disorders. However, its relationship with EAT thickness has not been studied yet. The study included 176 prediabetic and obese patients. EAT thickness was assessed using echocardiography. EAT thickness, TyG index, anthropometric obesity indices (body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR)), homeostatic model assessment (HOMA-IR), and biochemical parameters were compared. The following correlations between EAT thickness and related parameters were observed: WC ( = .529), BMI ( = .514), ALT ( = .358), TyG index ( = .338), and HOMA-IR ( = .322;  < .001 for all). Multiple regression analysis showed that WC (Beta = .428;  = .004), age (Beta = .223;  < .001), BMI (Beta = .196;  = .029), ALT (Beta = .168;  = .012), and TyG index (Beta = .128;  = .049) were the strongest independent variables correlated with EAT thickness. A model based on WC, BMI, age, TyG index, and ALT provided the best -square (.387) for estimating EAT thickness ( < .001). The TyG index showed a significant and independent relationship with EAT, suggesting that it may be useful as an indicator of EAT thickness.

Chemical adhesive closure (CAC) has comparable efficacy to thermal ablation but with faster recovery. Endovenous glue-induced thrombosis (EGIT) is a rare complication after CAC with lacking data regarding the prevalence and potential associations with deep vein thrombosis (DVT) and pulmonary embolism (PE). A retrospective chart analysis of patients treated with CAC at our institution between January 2018 and May 2022 was completed. Data collected included demographics, site and severity of chronic venous insufficiency (CVI), procedure details and outcomes at follow up visit. A comprehensive literature search of PubMed/Medline, Embase, and Cochrane was then conducted on December 2022, to include all studies that reported EGIT cases. The search generated 19 previous studies with a total of 2101 patients treated using CAC. The pooled prevalence rate of EGIT across these studies was 1.2% (95% CI: 0.3%-2.1%, I = 61.1%). There were two reported cases of CAC-related DVT and no related cases of PE. In our patient cohort, age, treated vein size or procedure complexity were not significantly associated with increased risk of EGIT. CAC is an effective treatment for CVI with a low prevalence of EGIT. There were two reported cases of CAC-related DVT and no PE.

Patients with autoimmune chronic inflammatory disease (CID) are at an increased risk of valvular heart disease, including aortic valve stenosis, insufficiency, or both. The impact of CID on the prognosis of surgical or transcatheter aortic valve replacement (AVR) remains unclear. This meta-analysis aims to evaluate the impact of CID on major clinical outcomes in this population. A comprehensive literature search of PubMed, Cochrane, and Embase databases was conducted to identify relevant studies. The primary endpoint was 30-day all-cause mortality between patients with CID and controls. Secondary endpoints included, long-term all-cause mortality, stroke and in-hospital infection. Statistical analysis included Risk Ratio (RR) with 95% confidence interval (CI) using the random-effects model. Five studies involving 572,351 patients were included in the meta-analysis. Patients with CID had a greater 30-day mortality (RR = 1.17, 95% CI: 1.09, 1.27;  < .001) and a higher rate of in-hospital infection (RR = 2.13, 95% CI: 1.03, 4.41;  < .001). No differences were observed in the other secondary endpoints. Patients with CID are at an increased risk of short-term all-cause mortality and in-hospital infections after AVR. Further studies are required to validate our results and define the optimal management of these patients.

Research has explored the relationship between inflammatory biomarkers and cardiovascular diseases, highlighting the potential prognostic significance of the high-sensitivity C-reactive protein (hs-CRP)/albumin (ALB) ratio. However, it remains unclear whether this ratio is associated with adverse prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). This retrospective cohort study included 752 STEMI patients undergoing PCI at Tianjin Chest Hospital between January 2017 and December 2018. During a median follow-up of 52 months, 183 cases (24.0%) experienced major adverse cardiovascular events (MACE) events and 75 cases (10.0%) died. Cox regression analysis demonstrated that hs-CRP/ALB was independently associated with MACE as both a continuous (hazard ratio [HR] 1.152, 95% CI 1.097-1.210,  < .001) and categorical variable (HR 1.257, 95% CI 1.084-1.458,  = .027). Similar findings were observed for all-cause mortality (HR 1.119, 95% CI 1.058-1.183,  < .001; HR 2.228, 95% CI 1.009-4.920,  = .032). The receiver operating characteristic (ROC) curve indicated that hs-CRP/ALB levels have predictive capability for overall mortality in patients (the area under the curve [AUC] = 0.68). hs-CRP/ALB levels independently correlate with poor long-term prognosis in STEMI patients with prior PCI.

Exosomes refer to a group of extracellular vesicles naturally released from mammalian cells with a diameter of 30-150 nm. Exosomes contain a variety of biologically active molecules, such as cytoplasmic proteins, chemokines, cytokines, and microRNA (miRNA). They are widely involved in intercellular communication and regulate the behavior of recipient cells. Venous thrombosis is a pathological change caused by vascular endothelial cell damage, hemodynamic changes, and the hypercoagulable state of blood. Exosomes from different cell sources are involved in the process of venous thrombosis. Exosomes can also be used as therapeutic carriers for tissue regeneration and drug delivery. Therefore, the study of exosomes is crucial for the formation, diagnosis, and treatment of venous thrombosis. In this review, we summarize the biological characteristics of exosomes and their mechanism of action in venous thrombosis. In addition, we also focused on its potential clinical applications, including as a diagnostic marker and therapeutic carrier for venous thrombosis.

Using the SYNTAX score (SS) for decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for left main coronary artery (LMCA) revascularization is under scrutiny. This study investigated the clinical outcomes of LMCA revascularization stratified by SS. This multicenter study included 2138 patients recruited between 2015 and 2020 who underwent LMCA disease revascularization using PCI or CABG and were categorized based on their SS into three groups: low (≤22), intermediate (23-32), and high (≥33). Patients with a high SS compared with those with an intermediate SS experienced increased hospital mortality (Odds ratio: 1.99;  = .026) and Major Adverse Cardiac and Cerebrovascular Event (MACCE; OR: 2.17;  = .006). With an average follow-up of 24.7 months, no substantial differences emerged in MACCE (Hazard ratio: 1.23;  = .52) or mortality (HR: 3.26;  = .073] between patients with high and intermediate SSs. A significant interaction between the SS category (low vs intermediate) and LMCA revascularization modality was observed for hospital MACCEs, favoring PCI over CABG (OR: 0.32;  = .033). However, no noteworthy interactions between SS categories and revascularization modalities were noted concerning hospital or follow-up mortality or follow-up MACCEs. These findings raise doubts about the utility of SS alone in selecting left-main revascularization modalities for LMCA disease.

Coronavirus 2019 (COVID-19) infection has a significant mortality rate. Despite the disease's extensive effects, little is known about the prognostic indicators that can be used. We aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCR) and platelet-to- lymphocyte ratio (PLR) in predicting mortality of intensive care unit (ICU) patients. Demographic data, underlying diseases, laboratory parameters were evaluated. The study included 222 cases. The mortality rate was 57.65%. No significant differences in terms of sex, age, or underlying disease were observed between the two groups with and without mortality. Obesity, oxygen therapy, invasive mechanical ventilation (IMV) rates and high SOFA (Sequential Organ Failure Assessment) scores were found to be significantly higher in the group with a mortal course. The mortality rate was significantly higher in patients with lung involvement over 50%, with a low lymphocyte count at ICU admission. In this patient group, NLR was found to be higher, and LCR was found to be lower ( = .001). Although there was no significant difference in PLR between the two groups in univariate analysis, multivariate analysis revealed that PLR was independently associated with mortality. High NLR and low LCR values at ICU admission might serve as early warning signs for healthcare providers, allowing them to identify patients at higher risk of mortality.

Three deficiencies of the Papa criteria (point scoring system, PSS) for thromboangiitis obliterans (TAO) were identified and updated. According to the new criteria, 185 patients with clinically diagnosed TAO in a single center using the diagnostic criteria of Shionoya were scored and re-diagnosed. The diagnostic criteria of The Japanese Ministry of Health, Labour and Welfare (JMHLW) were used as the comparative standard to compare the diagnostic value of the revised PSS (RPSS) criteria in the diagnosis of TAO. Among the 185 patients, 145 patients were possibly diagnosed with TAO by the RPSS diagnostic criteria, 40 patients were excluded from TAO diagnosis. The JMHLW standard definitively diagnosed 154 patients with TAO, and 31 patients were excluded from TAO diagnosis. Compared with the JMHLW standard, the accuracy of the RPSS diagnostic criteria was 0.90, and the Kappa value was 0.67 (Confidence interval [CI]: 0.53-0.81), which reached "substantial" agreement. The Area Under Curve (AUC) was 0.86 and >0.7, showing good diagnostic value. The RPSS criteria have good diagnostic efficacy. If this revised scoring system can be endorsed, it might improve the certainty of TAO diagnosis and research.

Non-atherosclerotic renal artery vasculopathies are rare and can be caused by heterogenous group of diseases, some of which has bad prognosis. The literature addressing this rare group of disease is scarce. A single center analysis of all adult patients evaluated for renal artery disease including dissection, aneurysm, stenosis, vasculitis, thrombosis, irregularity, and renal infarct treated at our center, from January 2000 to April 2022. Baseline data collected included demographics, comorbidities, vital signs, laboratory values, pathology, genetic testing, and imaging results/diagnoses. Additionally, treatment modality, follow-up, and symptom relief/recurrence from follow-up visits were collected if available. Out of the included 227 patients, 91 (40%) had renal infarction, 70 (31%) had renal artery dissection, 69 (30%) had aneurysm, 33 (15%) had stenosis, and 32 (14%) had thrombosis. The most common diagnoses were fibromuscular dysplasia ( = 86, 38%) and thromboembolism ( = 38, 17%). Most patients improved with conservative management, reserving endovascular or surgical interventions for symptomatic patients with more complicated presentations. To our knowledge, this is the only case study and general review in the literature that addresses the diagnosis and management of non-atherosclerotic renal arteriopathies showing good outcome for most of the underlying etiologies.