Background: The comparison of outcomes of mini‐crush (MCT) versus double kissing crush (DKC) techniques for complex left main bifurcation (LMB) lesions is still lacking. This investigation aimed to assess the long‐term outcomes of patients who underwent MCT or DKC for LMB disease. Methods: From 2014 to 2024, patients who underwent percutaneous coronary intervention for complex LMB lesions were retrospectively collected. The primary end point was major adverse cardiac events as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization during follow‐up. The secondary end point was measured as major adverse cardiovascular and cerebral events including all‐cause death, target vessel revascularization, target vessel myocardial infarction, stent thrombosis, and stroke. Results: This large‐scale multicenter (n=13) observational study included a total of 531 consecutive patients (men: 405 [76.3%], mean age: 63.16±11.26 years) with complex LMB lesions who underwent percutaneous coronary intervention. The initial revascularization strategy was MCT in 313 (59%) patients and DKC in 218 (41%) patients. The number of balloons used (5.91±1.53 versus 6.72±1.70, P <0.001) and procedure time (66.60±24.20 versus 72.97±19.97 minutes, P <0.001) were notably lower in the MCT group. In the overall population, the long‐term major adverse cardiac events (hazard ratio [HR], 0.704; P =0.169) and major adverse cardiovascular and cerebral events (HR, 0.660; P =0.079) did not differ in individuals with complex LMB lesions treated with MCT and DKC. Other end points were also comparable between the 2 groups. Conclusions: In complex LMB lesions, risk‐adjusted major adverse cardiac events and major adverse cardiovascular and cerebral events rates were comparable between both techniques, with a nonsignificant trend favoring DKC at long‐term follow‐up. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT06546748.

The Naples prognostic score (NPS) consists of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin levels, and total cholesterol (TC) levels. This study hypothesizes that the NPS may predict mortality in older patients with acute coronary syndrome (ACS). We conducted a retrospective study including 380 patients diagnosed with ACS at our hospital from May 2015 to December 2022. Older hospitalized patients (≥75 years of age) with ACS were divided by NPS into 2 groups: low NPS (0-2) and high NPS (3-4). The median follow-up time was 23 months. The primary outcome was long-term mortality from the day of admission. In-hospital mortality was 15.8% (n = 60 patients), and long-term mortality was 50.5% (n = 192). In the high-NPS group two, a higher rate of long-term mortality was observed (group 2, n = 123 [58%] vs group 1, n = 69 [41.1%], P < .001). In contrast, gender, diabetes mellitus, hypertension, SYNTAX score, or in-hospital mortality were not associated with NPS. In this study, these results demonstrated that high NPS values may be a predictor of all-cause mortality.

Background: In patients undergoing percutaneous coronary intervention (PCI), drug eluting stents (DES) are currently the standard of care. Stent design and alloy composition, biocompatibility of the drug-eluting polymer coating, the antiproliferative agent properties and release are the three main characteristics that affects DES performance. Cre8 (Alvimedica, Istanbul, Turkey) is a polymer-free amphilimus-eluting stents (PF-AES). In this study, we aimed to investigate the clinical efficacy and safety of Cre8 DES in daily cardiology practice. Methods: Patients presenting with chronic coronary syndrome (CCS) or acute coronary syndrome (ACS) including unstable angina pectoris (USAP), myocardial infarction with and without ST-segment elevation and treated with PCI using Cre8 DES between December 2015 and 2016 were retrospectively analyzed in this study. Results: Between December 2015 and 2016, 808 lesions of 664 patients treated with Cre8 DES in a single center were included in this retrospective analysis. The mean age of study group was 60 years (between 33 and 93 years) and were predominantly consisting of male patients (79.4%). The median follow-up duration was 487 days (min: 30 days, max: 919 days) and two-thirds of all patients presented with ACS. The culprit lesion was on left anterior descending artery (LAD) (40.5%) and right coronary artery (RCA) (25.9%) in most of the patients. The procedural success rate was 97.3%. Most of the lesions were type B1 (40.6%) according to American College of Cardiology/American Heart Association (ACC/AHA) coronary lesion classification. The device oriented primary end-point defined as target lesion failure (TLF) occurred in 52 (6.4%) of 808 lesions. The primary safety end-point was cardiac death in 20 patients (3.0%) and target vessel myocardial infarction in 2 patients (0.3%). Target vessel revascularization (TVR) occurred in 29 patients (4.4%) as primary safety endpoint. Multivariable logistic regression analysis revealed diabetes mellitus and ejection fraction as the predictors of mortality and device oriented primary end-point. Conclusions: This trial revealed clinical efficacy and safety of Cre8 stents in real world practice. Device oriented primary end points were similar with previous studies which are randomized, open label in nature and showed the efficacy and safety of Cre8 stent towards latest generation DES.

Aim: The potential effects of diabetes duration and glycemic control on ejection fraction (EF) in patients with heart failure (HF) remain unclear. We investigated the impact of diabetes duration and glycemic control on ejection fraction (EF), alongside other risk factors, in HF patients with type 2 diabetes mellitus (T2DM). Materials and methods: This single-center retrospective study included 1265 patients who were admitted and discharged with a diagnosis of HF between January 2010 and January 2022, all of whom had a known diagnosis of T2DM prior to admission. The patients included in the study were divided into two groups: those with heart failure and reduced ejection fraction (HFrEF, EF ≤ 40%) and those with or mid-range or preserved ejection fraction (HFmrEF + HFpEF, EF > 40%). Results: Among the 1265 patients, 697 had HFrEF. The duration of diabetes was significantly longer (13 vs. 7 years, p < 0.001) and HbA1c levels were higher (8.4 ± 1.6% vs. 7.7 ± 1.5%, p < 0.001) in the HFrEF group. Multivariable analysis identified diabetes duration (OR 2.23, p < 0.001), hypertension (OR:6.62, p < 0.001), and the use of oral antidiabetic agents (OR 0.74, p = 0.042) as independent predictors of reduced EF. Prolonged diabetes duration was associated with a reduction in EF (AUC = 0.780, p < 0.001). Conversely, although glycemic control was poorer in the HFrEF group, it was not an independent predictor of EF. Conclusion: Prolonged diabetes duration significantly reduces EF, among HF patients with T2DM, independent of glycemic control and other risk factors. While poor glycemic control was more prevalent in HFrEF patients, it did not independently affect EF.

Background: The C-reactive protein (CRP) -albumin- lymphocyte (CALLY) index has recently emerged as a promising prognostic marker, which reflecting inflammatory, nutrional and immunological statuses. However, no study has reported the prognostic value of the CALLY index in older patients with acute coronary syndrome (ACS). The aim of the study is to determine whether the CALLY index can serve as a reliable predictor of all- cause mortality in older patients with ACS. Methods: This study was conducted retrospectively in patients aged ≥ 75 years old with ACS. The study comprised 440 patients diagnosed with ACS at our hospital May 2015 to August 2024. The median follow-up time was 23 months. The CALLY index was computed using the formula: (serum albumin (g/dL)×lymphocyte (10 ⁹ /L)/CRP (mg/L)×10). The primary outcome was all-cause mortality from the day of admission. Results: A total of 475 ACS patients over 75 years old were ultimately enrolled in this study. 35 patients were excluded due to missing follow-up data and active infection. The patients were divided into two groups according to the CALLY index: low CALLY (≤ 0.083, n:219), high CALLY (> 0.083, n:221). The low CALLY index appears to be a valuable tool for predicting mortality in older patients with ACS. Kaplan–Meier analysis demonstrated that a low CALLY index was significantly associated with low survival rate. Our study revealed that the CALLY index provides statistically significant independent predictor in older patients' prognosis in all-cause mortality. All- cause mortality was 48.2% (n:212) in both groups. In the low CALLY index group, a higher rate of all- cause mortality was observed [group 1, n:130 (59.4%)]. Conclusions: Based on the findings of our study, the CALLY index appears to be a practical and easily applicable tool for assessing mortality risk in elderly patients with acute coronary syndrome.

Background/Objectives: Highly active antiretroviral therapy (HAART) effectively suppresses viral load and aids immunological recovery in HIV patients, but may still lead to subclinical myocardial dysfunction. This study assesses left and right ventricular functions in patients on HAART containing abacavir, dolutegravir, and lamivudine using Tissue Doppler Imaging (TDI). Methods: This observational cross-sectional study involved 118 HIV-positive adults on HAART and 80 age- and gender-matched healthy controls. Comprehensive echocardiographic assessments, including TDI, were conducted to evaluate myocardial performance index (MPI) and isovolumic acceleration (IVA). Results: Conventional echocardiographic parameters showed no significant differences; however, TDI indicated significant impairments in ventricular functions in the HAART group, with increased MPI and decreased IVA (p < 0.001). Pulmonary artery pressures were also higher in the HIV group (p = 0.012). There was a strong positive correlation between MPI and HAART duration (r = 0.675, p = 0.002), and a negative correlation with CD4 count (r = −0.545, p = 0.006). Conclusions: TDI reveals significant subclinical ventricular dysfunction in HIV patients on HAART, correlating with therapy duration and immune status. These findings underscore the utility of TDI in detecting myocardial deterioration before clinical symptoms appear.