Background: The comparison of outcomes of mini‐crush (MCT) versus double kissing crush (DKC) techniques for complex left main bifurcation (LMB) lesions is still lacking. This investigation aimed to assess the long‐term outcomes of patients who underwent MCT or DKC for LMB disease. Methods: From 2014 to 2024, patients who underwent percutaneous coronary intervention for complex LMB lesions were retrospectively collected. The primary end point was major adverse cardiac events as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization during follow‐up. The secondary end point was measured as major adverse cardiovascular and cerebral events including all‐cause death, target vessel revascularization, target vessel myocardial infarction, stent thrombosis, and stroke. Results: This large‐scale multicenter (n=13) observational study included a total of 531 consecutive patients (men: 405 [76.3%], mean age: 63.16±11.26 years) with complex LMB lesions who underwent percutaneous coronary intervention. The initial revascularization strategy was MCT in 313 (59%) patients and DKC in 218 (41%) patients. The number of balloons used (5.91±1.53 versus 6.72±1.70, P <0.001) and procedure time (66.60±24.20 versus 72.97±19.97 minutes, P <0.001) were notably lower in the MCT group. In the overall population, the long‐term major adverse cardiac events (hazard ratio [HR], 0.704; P =0.169) and major adverse cardiovascular and cerebral events (HR, 0.660; P =0.079) did not differ in individuals with complex LMB lesions treated with MCT and DKC. Other end points were also comparable between the 2 groups. Conclusions: In complex LMB lesions, risk‐adjusted major adverse cardiac events and major adverse cardiovascular and cerebral events rates were comparable between both techniques, with a nonsignificant trend favoring DKC at long‐term follow‐up. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT06546748.

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S’, or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis.

The aim of this study was to evaluate which critical coronary artery stenosis is more arrhythmogenic in stable coronary artery disease and whether the involved stenotic artery or the size of the myocardial tissue under ischemia due to stenosis is more important in terms of malignant ventricular arrhythmias by using arrhythmia predictors calculated on electrocardiography. This was a retrospective observational study. We scanned patients who underwent percutaneous coronary intervention for single vessel stable coronary artery disease between January 2013 and 2016. Assigned indicators of increased arrhythmogenic risk as TpTe interval, QTc interval and TpTe/QT ratio were calculated on electrocardiography before and after the percutaneous coronary intervention. We also calculated the anatomical myocardial area at risk of ischemia as a percentage of the left ventricular myocardium volume for a given site of lesion with APPROACH score by assessing coronary angiography images. The percentage of left ventricular jeopardized myocardium in left anterior descending artery lesions (34±10) was significantly higher than those in circumflex artery (17±11) and right coronary artery (21±5) lesions (p<0.001). Furthermore, the differences between TpTe intervals and TpTe/QT ratios measured before and after the percutaneous coronary intervention were significantly higher in patients with left anterior descending artery lesions than patients with circumflex artery and right coronary artery lesions (p<0.001). In patients with stable coronary artery disease, the size of the ischemic myocardium was associated with increased arrhythmogenesis. Patients with left anterior descending artery lesions may get the greatest benefit from revascularization in terms of arrhythmia predictors calculated on electrocardiography.