(1) Introduction: Cancer and atrial fibrillation (AF) are increasingly coexisting medical challenges. These two conditions share an increased thrombotic and bleeding risk. Although optimal regimens of the most suitable anti-thrombotic therapy are now affirmed in the general population, cancer patients are still particularly understudied on the matter; (2) Aims And Methodology: This metanalysis (11 studies (incl. 266,865 patients)) aims at evaluating the ischemic-hemorrhagic risk profile of oncologic patients with AF treated with oral anticoagulants (vitamin K antagonists vs. direct oral anticoagulants); (3) Results: In the oncological population, DOACs confer a benefit in terms of the reduction in ischemic, hemorrhagic and venous thromboembolic events. However, ischemic prevention has a non-insignificant bleeding risk, lower than Warfarin but significant and higher than the non-oncological patients; (4) Conclusions: Anticoagulation with DOACs provides a higher safety profile with respect to VKAs in terms of stroke reduction and a relative bleeding reduction risk. Further studies are needed to better assess the optimal anticoagulation strategy in cancer patients with AF.

Background: Coronary bifurcation lesions (CBL) account for ~20% of percutaneous coronary interventions (PCI). When using provisional stenting, optimal management of a diseased side branch (SB) remains debated. Drug‐coated balloons (DCBs) are an emerging option, but data on their role in CBL PCI are limited. Aims: We conducted a meta‐analysis to compare DCBs and non‐compliant balloons (NCBs) for SB treatment. Methods: A systematic search of MEDLINE, CENTRAL, and EmBase (until November 2024) identified studies comparing DCBs and NCBs for treating the SB. From 1451 studies, five were included (two randomized controlled trials [RCTs], three observational), with 1762 patients, predominantly male with acute coronary syndrome (ACS). The primary outcome was major adverse cardiac events (MACE); secondary outcomes included myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: DCBs significantly reduced MACE (pooled OR 0.48, 95% CI 0.34–0.68, p < 0.0001, I ² = 0%) and MI (pooled OR 0.39, 95% CI 0.25–0.62, p < 0.001, I ² = 0%) compared to NCBs. No significant differences were observed in TLR or TVR. Subgroup analysis confirmed consistency across observational studies and RCTs for MACE and MI. Conclusions: DCBs in SB treatment during CBL PCI are associated with reduced MACE and MI compared to NCBs, with no significant differences in vessel‐specific outcomes. These findings suggest a potential clinical benefit of DCBs in reducing ischemic events, while limiting stenting in CBL. Further research is needed to refine patient selection and optimize outcomes.

Background: Lipoprotein(a) [Lp(a)] is an inherited cardiovascular risk factor, but its relationship with coronary anatomical complexity, plaque phenotype, and outcomes after percutaneous coronary intervention (PCI) remains incompletely defined. Methods: We conducted a systematic review and meta-analysis of studies evaluating the association between circulating Lp(a) levels and coronary disease characteristics, post-PCI clinical outcomes, stent-related adverse outcomes, and aortic valve disease. Results: Twenty-six studies were included. Elevated Lp(a) levels were associated with greater coronary anatomical complexity and a higher risk of major adverse cardiovascular events after PCI (HR 1.4, 95% CI 1.2–1.7). The strongest associations were observed for stent-related adverse outcomes, including restenosis (OR 3.23, 95% CI 2.2–4.8) and target vessel revascularization (OR 2.6, 95% CI 1.6–4.4). Higher Lp(a) levels were also associated with vulnerable plaque features and aortic valve calcification. Conclusions: Elevated Lp(a) is associated with greater coronary disease complexity and adverse outcomes after PCI. Elevated Lp(a) may represent a biological marker identifying high-risk patients and providing additional insight for personalized risk stratification and procedural decision-making in patients undergoing PCI.

Introduction: Peri-procedural myocardial infarction (PMI) after cardiac surgery is a significant yet often under-recognised complication, sometimes necessitating urgent coronary angiography (PMI-rCA). This meta-analysis evaluates its prevalence, angiographic findings, management strategies, and associated mortality. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Data from nine studies comprising 104,445 post-cardiac surgery patients were analysed. Among them, those undergoing PMI-rCA were categorised by treatment strategy: conservative management, percutaneous coronary intervention (PCI), or reperform surgery. A network meta-analysis compared mortality risks across these groups, with findings visualised using forest plots, network diagrams, and SUCRA rankings. Results: PMI-rCA was performed in 1205 patients (2%). Of these, 34.3% had no significant angiographic abnormalities, 53.7% exhibited graft failure, and 10.4% had native vessel ischemia. Management strategies included conservative treatment (55.5%), PCI (23.5%), and reperforming surgery (21%). Network meta-analysis indicated that conservative management was associated with the lowest mortality risk, followed by PCI, while reperforming surgery had the highest risk. Discussion: These findings highlight the complexity of PMI diagnosis and treatment. The high proportion of patients without significant angiographic abnormalities raises concerns about potential overuse of invasive procedures. Meanwhile, PCI appears to be a more favourable interventional strategy than reperforming surgery in terms of mortality outcomes. Conclusions: PMI requiring coronary angiography is uncommon but clinically significant, with a 16% mortality rate. A tailored, risk-based approach is essential to optimise management, balancing conservative therapy, PCI, and reperforming surgery based on individual patient profiles.

Background: Delirium is a common, underdiagnosed neuropsychiatric syndrome in older adults, associated with high mortality and functional decline. Given its multifactorial nature and overlap with frailty, radiological markers may improve risk stratification in the emergency department (ED). Methods: We conducted a retrospective study on a small sample of 30 patients diagnosed with delirium in the emergency department who had recently undergone brain, thoracic, or abdominal CT scans for unrelated clinical indications. Using post-processing software, we analyzed radiological markers, including coronary artery calcifications (to estimate vascular age), cerebral atrophy (via the Global Cortical Atrophy scale), and cachexia (based on abdominal fat and psoas muscle volumetry). Results: Five domains were identified as significant predictors of 12-month mortality in univariate Cox regression: vascular age, delirium etiology, cerebral atrophy, delirium subtype (hyperactive vs. hypoactive), and cachexia. Based on these domains, we developed an exploratory 10-point delirium score. This score demonstrated acceptable diagnostic accuracy for mortality prediction (sensitivity 0.93, specificity 0.73, positive predictive value 0.77, negative predictive value 0.91) in this limited cohort. Conclusions: While preliminary and based on a small, retrospective sample of 30 patients, this multidimensional approach integrating clinical and radiological data may help improve risk stratification in elderly patients with delirium. Radiological phenotyping, particularly in terms of vascular aging and sarcopenia/cachexia, offers objective insights into patient frailty and could inform more personalized treatment pathways from the ED to safe discharge home, pending further validation.

Aims: Pulsed field ablation (PFA) is a non-thermal energy modality for ablation of atrial fibrillation (AF). Although PFA has demonstrated an excellent overall safety profile, increasing evidence suggests an association with intravascular haemolysis, and acute kidney injury (AKI). However, the extent of haemolysis across different PFA catheters remains poorly characterized and warrants further investigation. Methods and results: We prospectively enrolled 239 patients undergoing AF ablation using the pentaspline (n = 107), balloon-in-basket (n = 71), or lattice-tip (n = 61) catheter. Laboratory markers of haemolysis, myocardial injury, renal function and haemoglobin were collected pre- and 24h post-procedure. Significant haptoglobin depletion was observed exclusively with pentaspline, [pre 99.8 mg/dL (70.2–122) vs. post 55.7 mg/dL (23.2–91.8); P < 0.001] Reductions with the lattice-tip (P = 0.074) and the balloon-in-basket (P = 0.201) catheter did not reach statistical significance. AKI was only observed with the pentaspline catheter (pentaspline: 4.9%; balloon-in-basket: 0.0%; lattice tip: 0.0%; P = 0.020). Myocardial markers increased across all groups, but significantly higher in pentaspline and balloon-in-basket (P = n.s.) vs. lattice-tip (P < 0.001 vs. pentaspline, P < 0.001 vs. balloon in basket). Conclusion: In this large cohort, contemporary PFA systems appear safe but catheter design influences the extent of haemolysis, AKI, and myocardial injury. The pentaspline catheter was associated with the greatest haemolytic effect and higher transient AKI, without clinically relevant reductions in haemoglobin or persistent renal impairment. Higher levels of myocardial injury in the pentaspline and balloon-in-basket groups correspond to the larger lesion footprints of these devices.