Aim: Coronary bifurcation atherosclerosis depends on its angles, flow, and extensive branching. We investigate the ability of CT coronary angiography (CTCA) to determine atherosclerotic plaque characteristics of “true” bifurcation compared with intravascular ultrasound (IVUS) and the influence on side branch (SB) fate after percutaneous coronary intervention (PCI).Methods and results: The study included 70 patients with 72 “true” bifurcations. Most of the bifurcations were in the left anterior descending—diagonal (Dg) territory [50 out of 72 (69.4%)]. Longitudinal plaque evaluation at the polygon of confluence [carina and 5 mm proximal and distal in the main branch (MB)] showed that carina side MB and SB plaque had occurred with the lowest incidence with fibro-lipid structure (115 ± 63 HU and 89 ± 73 HU, p < 0.001 for all). Bland–Altman analysis showed a discrepancy in measuring mainly the lumen area between CTCA and IVUS in proximal MB [lumen 5.10, 95% CI (95% confidence interval, 4.53–5.68) mm², p < 0.001; vessel −1.42, 95% CI (−2.63 to −0.21) mm², p = 0.023], carina MB [lumen 3.74, 95% CI (3.37–4.10) mm², p < 0.001; vessel −0.48, 95% CI (−1.45 to 0.48) mm², p = 0.322], and distal MB [lumen 4.72, 95% CI (4.27–5.18) mm², p < 0.001; vessel 0.62, 95% CI (−0.53 to 1.77) mm², p = 0.283]. A significant correlation existed between average plaque density on CTCA with a percentage of calcified plaque on IVUS tissue characterization (proximal r = 0.307/p = 0.024, carina 0.469/0.008, distal 0.339/0.024, minimal lumen diameter 0.318/0.020). Circumferential plaque in the proximal MB segment remained an independent predictor of SB compromise [OR 3.962 (95% CI 1.170–13.418)].Conclusion: Detection and characterization of atherosclerotic plaque by CTCA in non-left main “true” coronary bifurcations can provide useful information about bifurcation anatomy and plaque distribution that can predict outcomes after provisional stenting, thus guiding the interventional strategy to bifurcation PCI.

Background and Objectives: ACS presents an acute manifestation of coronary artery disease and its treatment is based on timely interventional diagnostics and PCI. It has been known that the treatment and the outcomes are not the same for all the patients with ACS during the working day, depending on the availability of the procedures and staff. The aim of the study was to explore the differences in clinical characteristics and outcomes in patients admitted for ACS during on- and off-hours. Materials and Methods: The retrospective study included 1873 consecutive ACS patients admitted to a tertiary, university hospital that underwent coronary angiography and intervention. On-hours were defined from Monday to Friday from 07:30 h to 14:30 h, while the rest was considered off-hours. Results: There were more males in the off-hours group (on-hours 475 (56%) vs. off-hours 635 (62%); p = 0.011), while previous MI was more frequent in the on-hours group (on 250 (30%) vs. off 148 (14%); p < 0.001). NSTEMI was more frequent during on-hours (on 164 (19%) vs. off 55 (5%); p < 0.001), while STEMI was more frequent during off-hours (on 585 (69%) vs. off 952 (93%); p < 0.001). Patients admitted during on-hours had more multivessel disease (MVD) (on 485 (57%) vs. off 489 (48%); p = 0.006), as well as multivessel PCI (on 187 (22%) vs. off 171 (16%); p = 0.002), while radial access was preferred in off-hours patients (on 692 (82%) vs. off 883 (86%); p = 0.004). Left main PCI was performed with similar frequency in both groups (on 37 (4%) vs. off 35 (3%); p = 0.203). Death occurred with similar frequency in both groups (on 17 (2.0%) vs. off 26 (2.54%); p = 0.404), while major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group (on 105 (12.4%) vs. off 70 (6.8%); p = 0.039) probably due to the more frequent repeated PCI (on 49 (5.8%) vs. off 27 (2.6%); p = 0.035). Conclusions: Patients admitted for ACS during working hours in a tertiary hospital present with more complex CAD, have more demanding interventions, and experience more MACCEs during follow-up mostly due to myocardial infarctions and repeated procedures.

(1) Aims: This study aimed to compare cardiovascular outcomes in patients older than 75 years with those of younger patients who underwent interventional treatment for acute coronary syndrome (ACS) at a tertiary university hospital. (2) Methods and Results: This was a retrospective, observational study conducted between January 2016 and December 2021, including 1846 consecutive patients with ACS (older than 75 years n = 203, 11%; younger than 75 years n = 1643, 89%). After admission, patients underwent coronary angiography and subsequently received percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy. The mean age in the older group (O75) was 80 ± 4 years versus 59 ± 9 years in the younger group (Y75) (p < 0.001). Older patients more frequently presented with multivessel coronary disease (O75: 114 [56%] vs. Y75: 727 [44%], p = 0.004), and the left anterior descending artery (LAD) was more often the culprit vessel (O75: 105 [52%] vs. Y75: 684 [41%]). Major adverse cardio-cerebral events (MACCEs) occurred more frequently in patients older than 75 years, mainly due to higher mortality (O75: 14 [6.9%] vs. Y75: 27 [1.6%], p < 0.001) and stroke (O75: 3 [1.5%] vs. Y75: 2 [0.1%], p < 0.001). Multivessel disease was the only factor independently associated with MACCEs (HR 1.417, 95% CI 1.058–1.898, p = 0.02). The incidence of significant bleeding (Bleeding Association Research Consortium (BARC) class ≥ 3) was similar between groups (Y75: 123/1643 [7.5%] vs. O75: 13/203 [6.5%], p = 0.587). (3) Conclusions: Patients older than 75 years have worse short- and long-term prognoses following ACS compared with younger patients. Special attention and a multidisciplinary, personalized approach are required to optimize outcomes in this population.