Background: Visual estimation (VE) of coronary stenoses is the first step during invasive coronary angiography. The aim of this study was to evaluate the accuracy of VE together with invasive functional assessment (IFA) in defining the functional significance (FS) of coronary stenoses based on the opinion of multiple operators. Methods: Fourteen independent operators visually evaluated 133 coronary lesions which had a previous FFR measurement, indicating the degree of stenosis (DS), FS and IFA intention. We determined the accuracy of FS prediction using several scenarios combining individual and group decision, considering IFA as deemed necessary by the operator or only in intermediate lesions. Results: The accuracy of VE in predicting FS was largely variable between operators (average 66.1%); it improved significantly when IFA was used either as per operator’s opinion (86.3%; p < 0.0001) or only in intermediate DS (82.9; p < 0.0001). There was no significant difference between using IFA per observer’s opinion or only in intermediate DS lesions (p = 0.166). The poorest accuracy of VE for FS was obtained in intermediate DS lesions (59.1%). Conclusions: There are significant inter-observer differences in reporting the degree of DS, while the accuracy of VE prediction of FS is also largely dependent on the operator, and the worst performance is obtained in the evaluation of intermediate DS.

During the coronavirus pandemic 2019 (COVID-19), some studies showed differences in the profile of subjects presenting with acute coronary syndromes as well as in overall mortality due to the delay of presentation and other complications. The purpose of this study was to compare the profile and outcomes, with emphasis on all-cause in-hospital mortality, of ST-elevation myocardial infarction (STEMI) subjects presenting to the emergency department during the pandemic period compared with a control group from the previous year, 2019. The study enrolled 2011 STEMI cases, which were divided into two groups—pre-pandemic (2019–2020) and pandemic period (2020–2022). Hospital admissions for a STEMI diagnosis sharply decreased during the COVID-19 period by 30.26% during the first year and 25.4% in the second year. This trend was paralleled by a significant increase in all-cause in-hospital mortality: 11.5% in the pandemic period versus 8.1% in the previous year. There was a significant association between SARS-CoV-2 positivity and all-cause in-hospital mortality, but no correlation was found between COVID-19 diagnosis and the type of revascularization. However, the profile of subjects presenting with STEMI did not change over time during the pandemic; their demographic and comorbid characteristics remained similar.

Residual inflammatory risk after acute coronary syndromes (ACSs) remains a critical contributor to atherosclerosis progression and plaque destabilization. Inflammatory biomarkers such as interleukin-1 receptor antagonist (IL-1ra), resistin, and C-reactive protein (CRP) may provide additional insights into coronary lesion complexity and vulnerability. The main aim of the study was to evaluate the association of interleukin-1 receptor antagonist (IL-1ra), resistin, and C-reactive protein (CRP) with coronary disease extent; functional significance of non-culprit lesions, assessed by fractional flow reserve (FFR); and plaque vulnerability, assessed by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS). This prospective study enrolled 93 ACS patients undergoing invasive coronary assessment for an ACS. Inflammatory biomarkers were measured at admission and 6 months post-event. Patients were stratified post hoc into tertiles by biomarker distribution. SYNTAX score, FFR, and OCT-defined thin-cap fibroatheroma (TCFA) were used to characterize lesion burden and morphology. Multivariate logistic regression was performed adjusting for conventional cardiovascular risk factors and ACS type. Higher tertiles of IL-1ra, resistin, and CRP were significantly associated with increased SYNTAX score (p < 0.05), FFR < 0.80 (68% in the highest tertile), and presence of TCFA (62% vs. 20%, p < 0.01). All biomarkers correlated with coronary disease severity. In multivariate logistic models, IL-1ra (OR 1.23 per 100 pg/mL, p = 0.03), resistin (OR 2.35 per 1 ng/mL, p = 0.001), and CRP (OR 1.11 per 0.001 ng/mL, p = 0.006) independently predicted high-risk coronary profiles. IL-1ra, resistin, and CRP are independently associated with lesion complexity, functional significance, and vulnerability in ACS. Inflammatory biomarker profiling may provide complementary anatomical and physiological assessment in future ACS risk stratification strategies.

(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.

People living with human immunodeficiency virus have an increased cardiovascular risk due to higher prevalence of traditional risk factors, such as smoking, dyslipidemia, hypertension, diabetes, or obesity, and particular risk factors, such as inflammation, endothelial dysfunction, and antiretroviral therapy. Thus, people living with human immunodeficiency virus can develop accelerated atherosclerosis. The incidence of coronary artery disease in these patients may be twice as high compared with that of HIV-negative individuals with similar characteristics. “Porcelain aorta” is a term used to describe extensive circumferential calcification of the thoracic aorta. The pathophysiology of porcelain aorta is not fully understood. We present a case of a young man who was a smoker and living with HIV since childhood, without other traditional cardiovascular risk factors, who presented to the emergency room with a positive stress test for myocardial ischemia. Transthoracic echocardiography revealed normal regional and global myocardial wall motion, ascending aorta ectasia, and moderate aortic regurgitation. Coronary angiography showed a critical calcified proximal left anterior descending artery stenosis and an important calcification of the thoracic aorta. Therefore, the most important challenge was the management of coronary syndrome in a young person living with HIV, with associated porcelain aorta and aortic regurgitation.

Background: Coronary artery disease (CAD) remains a significant global health concern, being one of the most important contributors to morbidity and mortality worldwide. Accurate assessment of coronary lesions is crucial for guiding appropriate interventions and optimizing patient outcomes. Patients with acute myocardial infarction represent a population which is rarely selected in studies of intracoronary hemodynamics. Fractional Flow Reserve (FFR) has emerged as a valuable physiological index for evaluating the functional significance of coronary lesions, although the data of intravascular hemodynamic evaluation in patients with acute myocardial infarction is scarce [1-3]. In recent years, advancements in intravascular imaging techniques, such as Optical Coherence Tomography (OCT), have provided detailed insights into coronary anatomy both in acute or elective settings. [4-7]. Methods: This article aims to explore the correlation between different non-culprit vessel OCT-parameters and FFR value in the patients with recent acute myocardial infarction. The study included 114 patients with acute myocardial infarction (ST elevation myocardial infarction and non ST elevation myocardial infarction)for whom primary PCI (percutaneous coronary intervention) was performed for the culprit lesion. The non-culprit vessels with intermediate coronary stenoses (157 lesions) were evaluated in a staged procedure (during the index hospitalization) with OCT, FFR and revascularization was performed accordingly. Minimal luminal area (MLA) and percent luminal area stenosis (PSA) were analyzed in relation with the FFR value. Results: There is good correlation between OCT-derived parameters and FFR values in patients with recent acute myocardial infarction. Minimal luminal area (MLA) and percent luminal stenosis area (PSA) were independent predictors of FFR< 0,80 in multivariate logistic regression analysis. A value of 2,08 mm2 for the MLA and 76,85 % for the PSA have proved to be the best cut-offs for predicting a FFR< 0,80. Conclusions: OCT parameters are valuable additional tools in current angiographic practice, including patients with acute myocardial infarction, with the ability to bring numerous direct imagistic and indirect hemodynamic information.