Aims: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. The aim of this study was to investigate the possible predictive value of blood urea nitrogen-to-albumin ratio (BAR) for the LVA formation in acute ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PCI). Methods and results: A total of 1123 consecutive patients with STEMI were prospectively enrolled. The clinical and laboratory data were compared between LVA group and non-LVA group. Multivariable logistic regression analysis was performed to assess the independent risk factors of LVA formation. Predictive power of BAR and composite variable for LVA formation were assessed using receiver operating characteristic curve. LVA was detected in 162 patients (14.4%). The BAR was significantly higher in patients with LVA [0.16 (0.13–0.19) vs. 0.13 (0.10–0.17), P < 0.001]. Multivariable logistic regression analysis revealed that left ventricular ejection fraction (LVEF) [odds ratio (OR) = 0.865, P < 0.001], culprit vessel–left anterior descending artery (LAD) (OR = 4.705, P < 0.001), and BAR (OR = 2.208, P = 0.018) were all independent predictors for LVA formation. The predictive value of BAR remained significant even after cross-validation by splitting population into training set (OR = 1.957, P = 0.034) and validation set (OR = 1.982, P = 0.039). The maximal length and width of LVA were significantly increased in patients with BAR ≥ 0.15 when compared with BAR < 0.15 (3.37 ± 1.09 vs. 2.92 ± 0.93, P = 0.01, for maximal length, and 2.20 ± 0.55 vs. 1.85 ± 0.63, P = 0.001, for maximal width). The discriminant power of BAR for LVA is 0.723, which is superior to both blood urea nitrogen (C statistic = 0.586, P < 0.001) and albumin (C statistic = 0.64, P < 0.001). The combination of BAR, LVEF, and culprit vessel–LAD could significantly increase the predictive ability (C statistic = 0.874, P < 0.001, for vs. BAR). Subgroup analysis of age, sex, hypertension, diabetes, smoking, LVEF, serum albumin, multiple-vessel disease, and Gensini score had no effect on the association between BAR and risk of LVA formation (P < 0.05 for all subgroups). Conclusions: A higher BAR was an independent predictor for LVA formation in STEMI patients with primary PCI.

Background: Left ventricular aneurysm (LVA) often occurs as a complication following an acute myocardial infarction. This research focused on assessing the ability of the fibrosis-4 (FIB-4) index to predict LVA formation in individuals with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).Methods: We included 1,384 consecutive patients diagnosed with STEMI and compared their clinical and laboratory data between the LVA group and the non-LVA group. To determine the independent risk factors for LVA formation, multivariable logistic regression analysis was employed. Restricted cubic spline (RCS) analysis was conducted to evaluate the nonlinear relationship between FIB-4 index and LVA formation. The ROC curve was used to determine the predictive capability of the FIB-4 index and composite variable for LVA formation.Results: LVA occurred in 12.7% of the population. An elevated FIB-4 index correlated with a higher occurrence of LVA (19% vs. 9.3%, P < 0.001). In the LVA group, the FIB-4 index was higher than in the non-LVA group [1.8 (1.1–4.6) vs. 3.5 (1.4–8.1), P < 0.001]. Analysis using multivariable logistic regression showed that the FIB-4 index independently correlated with LVA risk (OR = 1.73, P = 0.004). The analysis using RCS uncovered a nonlinear correlation between a higher FIB-4 index and a heightened risk of LVA (Nonlinear P = 0.009). Additionally, the area under the ROC curve for the FIB-4 index in predicting LVA was 0.617. The composite variable comprising the FIB-4 index, left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and left anterior descending artery (LAD) as culprit vessel significantly improved the predictive power (C statistic = 0.722).Conclusion: An increased FIB-4 index was positively associated with LVA formation in patients with acute STEMI who underwent primary PCI.

Aldehyde dehydrogenase 2 (ALDH2) is a key enzyme that facilitates the biologic metabolism of nitroglycerin. However, no study investigated the association between ALDH2 gene polymorphism and the vasodilation of coronary arteries after intracoronary administration of nitroglycerin. In this study, we enrolled 427 patients with suspected angina pectoris. ALDH2 genotyping was performed and all patients were given 200 µg nitroglycerin in the right coronary artery during the coronary angiography. The invasive hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure, and heart rate were monitored. The reference diameter and stenosis diameter of the right coronary artery were measured with the Stenosis Analysis 1.6 software. Both wild-type and mutant-type groups exhibited significant decreases in SBP, diastolic blood pressure values, and increases in heart rate value after administration of nitroglycerin ( P < 0.05). The wild-type group showed significantly higher absolute difference values in SBP than the mutant-type group ( P < 0.05). The mutant-type group exhibited significantly lower difference values and rates of change in reference diameter than the wild-type group [0.3 ± 0.3 vs. 0.5 ± 0.2, P < 0.001 for the difference value of diameter; 9.6 ± 9.5 vs. 15.8 ± 8.5, P < 0.001 for the rate of change (%)]. Conversely, no differences were observed between the wild-type and mutant-type groups in terms of the difference value and rate of change of the stenosis diameter ( P > 0.05). In conclusion, ALDH2 gene polymorphism (Glu504Lys) is associated with changes in invasive hemodynamic parameters and coronary artery diameter after intracoronary injection of nitroglycerin.

Background: Left ventricular aneurysm (LVA) is a major mechanical complication following acute ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the predictive ability of the lactate dehydrogenase to albumin ratio (LAR) for the risk of LVA among STEMI patients. Methods: The study was conducted from July 2018 to 2025 across three medical centers in China. The study cohort comprised STEMI patients who underwent primary percutaneous coronary intervention across three medical centers. Multivariate logistic regression analysis and Restricted cubic spline plots were employed to assess the association between different LAR levels and LVA risk. Subgroup analyses were conducted to assess the consistency of the result. Results: The study included 551, 471, and 1384 eligible participants from the first, second, and third cohort, respectively. After adjusting for potential confounders, individuals in the highest quartile of LAR (Q4) demonstrated a significantly elevated risk of developing LVA compared to those in the lowest quartile (Q1) across all cohorts (First cohort: OR = 3.63, 95% CI = 1.65 - 7.96, P = 0.001; Second cohort: OR = 6.01, 95% CI = 2.22 - 16.26, P< 0.001; Third cohort: OR = 2.41, 95% CI = 1.47 - 3.96, P< 0.001). RCS analysis revealed a positive linear association between LAR and the risk of LVA across the three cohorts (overall P> 0.05). The predictive capacity of LAR for assessing LVA risk exceeded that of both lactate dehydrogenase and albumin (P< 0.05). Subgroup analyses further reinforced the robustness of these findings. Conclusion: An elevated LAR was independently associated with an increased risk of LVA development in patients with STEMI who underwent primary PCI.