Background and Objectives: The revascularization strategy for percutaneous coronary intervention (PCI) in patients with multivessel (MV) acute coronary syndrome (ACS) remains controversial. Certain gaps in the evidence are related to the optimal timing of non-culprit lesion revascularization and the utility of instantaneous wave-free ratio (iFR) in the management of MV ACS intervention. The major benefits of iFR utilization in MV ACS patients in one-stage complete revascularization are: (1) the possibility to virtually plan the PCI, both the location and the extension of the necessary stenting to achieve the prespecified final hemodynamic result; (2) the opportunity to validate the final hemodynamic result of the PCI, both in culprit artery and all non-culprit arteries and (3) the value of obliviating the uncomfortable, costly, time consuming and sometimes deleterious effects from Adenosine, as there is no requirement for administration. Thus, iFR use fosters the achievement of physiologically appropriate complete revascularization in MV ACS patients during acute hospitalization. Materials and Methods: This pilot study was aimed to test the feasibility of a randomized trial research protocol as well as to assess patient safety signals of co-registration iFR-guided one-stage complete revascularization compared with that of standard staged angiography-guided PCI in de novo patients with MV ACS. This was a single-center, prospective, randomized, open-label clinical trial consecutively screening patients with ACS for MV disease. The intervention strategy of interest was iFR-guided physiologically complete one-stage revascularization, in which the virtual PCI planning of non-culprit lesions and the intervention itself were performed in one stage directly following treatment of the culprit lesion and other critical stenosis of more than ninety percent. Seventeen patients were recruited and completed the 3-month follow-up. Results: Index PCI duration was significantly longer while the volume of contrast media delivered in index PCI was significantly greater in the iFR-guided group than in the angiography-guided group (119.4 ± 40.7 vs. 47 ± 15.5 min, p = 0.004; and 360 ± 97.9 vs. 192.5 ± 52.8 mL, p = 0.003). There were no significant differences in PCI-related major adverse cardiovascular events (MACE) between the groups during acute hospitalization and at 3-months follow-up. One-stage iFR-guided PCI requires fewer PCI attempts until complete revascularization than does angiography-guided staged PCI. Conclusions: Complete revascularization with the routine use of the virtual planning tool in one-stage iFR-guided PCI is a feasible practical strategy in an everyday Cath lab environment following the protocol designed for the study. No statistically significant safety signals were documented in the number of PCI related MACE during the 3-month follow-up.

Background and objectives: Myocardial perfusion imaging with cardiac single-photon emission tomography (SPECT) is widely available for the detection of coronary artery disease (CAD) with high diagnostic and prognostic accuracy for women. A large proportion of symptomatic women with true myocardial perfusion defects in SPECT referred to coronary angiography have an absence of CAD—a condition named INOCA (ischemia with nonobstructive CAD). Additionally, the INOCA endotypes are rarely correctly diagnosed, and therefore, no tailored therapy is prescribed. Materials and methods: The cardiac SPECT for women was performed from 2018 to 2021. Patients with perfusion defect were analyzed according to further prescribed diagnostic tests used to diagnose CAD. According to the diagnostic criteria, patients with INOCA were selected as candidates for invasive microvascular physiology measurements. The correlation was calculated between SPECT results and clinical characteristics, symptoms, and risk factors. Results: A total of 726 women with suspected CAD were analyzed. True myocardial perfusion defects were detected in 125 patients (17.2%). During coronary angiography in 70 (56.0%) women, atherosclerosis in epicardial arteries was not observed. In 17 (20.9%) patients, obstructive CAD was present. Correlation was found between perfusion defect in SPECT and cardiovascular risk factors, including overweight, obesity, arterial hypertension, and dyslipidemia. Women with typical angina were more likely to have INOCA, but with “noncardiac” symptoms—CAD. In total, 68 female patients met three inclusion criteria for INOCA and were selected as candidates for invasive diagnostic testing. Conclusions: The created registry proves the important role of cardiac SPECT and great need for the development of invasively detected physiological measurements. The combination of both interventions could significantly change the future directions for INOCA patients, improving treatment strategies and clinical outcomes, especially knowing the number of risk factors and varying clinical presentation. The study will be continued by performing invasive testing of coronary microvascular function to expand the competence about what is known about INOCA patients.

Evidence on cardiac remodeling, left ventricular (LV) function recovery, medication use and outcomes in older ST-segment elevation myocardial infarction (STEMI) patients is limited. We examined these aspects at baseline and evolution one year post-infarct in patients aged ≥ 80 versus < 80.STEMI registry data were retrospectively analyzed. The older subgroup included patients aged ≥ 80 years at index hospitalization. Echocardiography was performed at baseline and one year after STEMI. LV remodeling was defined as > 20% relative increase in the LV end-diastolic volume. One-year cardiovascular outcomes and five-year all-cause mortality are reported.Study included 2178 patients; 132 (6.1%) were aged ≥ 80. Older patients had worse baseline LV ejection fraction (47.2 ± 9.6% versus 49.8 ± 8.2%; p < 0.001) and experienced more adverse LV remodeling (29% versus 19%; p = 0.024). Nevertheless, LV function improved similarly in both groups. Beta-blocker and renin-angiotensin-aldosterone system inhibitor use was lower (86.4% versus 94.2%; p < 0.001 and 90.2% versus 96.5%; p < 0.001, respectively) but diuretic prescription higher (18.2% versus 8.1%; p < 0.001) in older patients. One year post-infarct beta-blocker and renin-angiotensin-aldosterone system inhibitor use decreased and was similar in both groups, but older patients continued to receive more diuretics and suffered higher heart failure hospitalization rates (7.0% versus 2.6%; p = 0.006). Five-year mortality was 25.8% in older versus 4.3% in younger patients (log-rank χ2 133.2; p < 0.001).Older patients experienced more adverse LV remodeling, received less beta-blockers and renin-angiotensin-aldosterone system inhibitors but more diuretics at discharge and one year, compared to younger patients. Nevertheless, LV function recovered similarly in both groups.

New-onset atrial fibrillation (AF) affects up to 21% of ST-segment elevation myocardial infarction (STEMI) patients. The value of LA reservoir strain to predict new-onset AF in a STEMI population has not been thoroughly investigated. We aimed to explore the incremental value of LA reservoir strain for predicting new-onset AF post-STEMI. Data were analyzed retrospectively from an ongoing STEMI registry. LA reservoir strain < 23% on transthoracic echocardiography was used as threshold for impaired LA function. The endpoint was new-onset AF. In total, 1238 patients (age 60 ± 12 years, 75% male) were included. After a median follow-up of 23 months, 92 (7.4%) patients developed new-onset AF. A similar prevalence of LA volume index ≥ 34 ml/m² was seen between post-STEMI patients who developed new-onset AF and those who did not. In contrast, impaired LA reservoir strain was 1.5 times more common in individuals who developed AF (72% versus 48%; p < 0.001). Cumulative, event-free survival rates at five years in patients with preserved versus impaired LA reservoir strain were 93% versus 84%, respectively (log-rank χ2 = 19.81; p < 0.001). On multivariate Cox regression analysis LA reservoir strain remained significantly associated with new-onset AF (HR 0.97 (95% CI: 0.94–0.99); p = 0.025). Addition of LA reservoir strain provided incremental prognostic value over baseline clinical and echocardiographic risk markers (χ2 56.93 vs. 59.98; p = 0.013). Impaired LA reservoir strain was 1.5 times more common in patients who experienced new-onset AF post-STEMI, and was of incremental value for predicting the development of AF after adjusting for clinical and echocardiographic risk factors. Graphical abstract Impaired LA reservoir strain was 1.5 times more common in patients who experienced new-onset AF post-STEMI, and was of incremental value for predicting the development of AF.

Unsaturated fatty acids have the potential to reduce residual cardiovascular risk. Sea buckthorn (Hippophae rhamnoides L.) contains several valuable bioactive substances, including lipids with a balanced fatty acid composition. The aim of this study was to evaluate the effects of sea buckthorn seed lipid extract (SBS-LE) on residual cardiovascular risk in high-risk patients. In this pilot study, 86 patients with chronic coronary syndrome receiving statin (atorvastatin or rosuvastatin) and/or ezetimibe were enrolled. SBS-LE capsules (1000 mg, twice daily) were prescribed in addition to standard medical therapy, with each capsule containing 300 mg of omega-3 alpha-linolenic acid, 370 mg of omega-6 linoleic acid, 170 mg of omega-9 oleic acid and 7 mg of the plant sterol beta-sitosterol. For this clinical trial, SBS-LE was produced via supercritical fluid extraction with carbon dioxide. Clinical effects and impacts on laboratory test results were evaluated at baseline and after three months. Additionally, lipidomics testing was performed to confirm the bioavailability of the formulation. Significant reductions in systolic blood pressure by 2.9 mmHg (2.1%, p = 0.012), LDL-C by 0.3 mmol/l (12.0%, p = 0.005) and CRP by 1.0 mg/l (37.0%, p = 0.032) were observed. These data suggest that SBS-LE may have potential as an add-on preventive strategy for residual cardiovascular risk reduction.