Despite significant goals achieved in diagnosis and treatment in recent decades, coronary artery disease (CAD) remains a high mortality entity and continues to pose substantial challenges to healthcare systems globally. After the latest guidelines, novel data have emerged and have not been yet considered for routine practice. The scope of this review is to go beyond the guidelines, providing insights into the most recent clinical updates in CAD, focusing on non-invasive diagnostic techniques, risk stratification, medical management and interventional therapies in the acute and stable scenarios. Highlighting and synthesizing the latest developments in these areas, this review aims to contribute to the understanding and management of CAD helping healthcare providers worldwide.

Clinical performance of a novel ultrathin strut, low-dose, sirolimus-eluting stent with abluminal-only biodegradable polymeric coating for patients undergoing percutaneous coronary intervention in the daily practice

Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. They might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external left main coronary compression by a giant aneurysm of the left sinus of Valsalva, which was successfully managed with percutaneous coronary intervention. Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. They might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external left main coronary compression by a giant aneurysm of the left sinus of Valsalva, which was successfully managed with percutaneous coronary intervention.

Background: Physiological pattern of coronary artery disease, whether focal or diffuse, is critical in guiding physicians during the decision‐making process for percutaneous coronary interventions. Aims: This study introduces two novel non‐hyperemic coronary physiology indices designed for longitudinal vessel analysis. Methods: In this prospective observational study, 415 patients underwent pressure‐wire functional assessments using instantaneous wave‐free ratio (iFR) pullback traces between March 2015 and November 2023 at Verona University Hospital. After applying exclusion criteria, the final study population comprised 198 patients with 209 intermediate coronary lesions. Vessels were qualitatively categorized as focal, diffuse, mixed‐focal, or mixed‐diffuse based on expert panel interpretation. The novel iFR Pullback Pressure Gradient (iPG) was derived from pullback curves to quantify the atherosclerotic pattern along the vessel. The local severity of lesions was assessed using the instantaneous iFR gradients per unit of length (diFR/ds). Additionally, based on Murray law‐based Quantitative Flow Ratio (µFR), both µFR‐PPGi and dµFR/ds were computed, to evaluate their correlation with iFR‐derived metrics. Results: The optimal iPG threshold for defining focal disease was 0.71 (Youden index = 0.456), demonstrating good accuracy in predicting the predominant disease pattern (AUC 0.785, p < 0.001). iPG provided an accuracy of 72%, with a sensitivity, specificity, positive predictive value, negative predictive value of 86.5%, 59%, 67.6%, 81.5%, respectively. The µFR‐PPGi and dµFR/ds showed significant correlations with iPG and diFR/ds, respectively (r = 0.238, p < 0.001; r = 0.528, p < 0.001). Conclusions: iPG and diFR/ds are novel quantitative indices for assessing physiological patterns of coronary artery disease, without the need for hyperemia induction. Moderate agreement between angio‐ and iFR‐based indices was found.

Candidates for transcatheter aortic valve implantation (TAVI) are currently evaluated using computed tomography angiography and invasive cardiac catheterization as an essential part of case selection and pre-procedure interventional planning. However, both imaging methods utilize iodinated agents, which may cause contrast-induced nephropathy, particularly in patients with baseline renal dysfunction. This study aimed to describe a zero-contrast imaging protocol for pre-TAVI evaluation in patients with advanced renal impairment. The pre-TAVI zero-contrast scheme consisted of the following multi-modality combinations: (1) gadolinium-free magnetic resonance imaging (three-dimensional navigator-echo with electrocardiogram-gated steady-state free-precession series); (2) iodinated-free multislice computed tomography electrocardiogram-gated; (3) lower limb arterial duplex scan ultrasound; and (4) transesophageal echocardiography. Ultimately, TAVI was performed for those deemed good candidates, and contrast was allowed during the intervention; however, operators were strongly advised to utilize the least volume possible of iodinated agents. This pilot survey included ten patients with symptomatic aortic stenosis and renal dysfunction who underwent zero-contrast multi-modality imaging. All the patients ultimately underwent TAVI. The intervention was successful in all cases, without ≥ moderate residual aortic regurgitation, prosthesis embolization, annulus rupture, major vascular complications, stroke, or death during index hospitalization. The creatinine clearance remained stable throughout the observation period (baseline: 26.85 ± 12.55 mL/min; after multi-modality imaging: 26.76 ± 11.51 mL/min; post-TAVI at discharge: 29.84 ± 13.98 mL/min; p = 0.3 all). The proposed contrast-free imaging protocol appears to be a promising clinical tool for pre-TAVI evaluation in patients with severe renal dysfunction.