Background: The aim of this study was to evaluate the prognostic values of five lymphocyte-based inflammatory indices (platelet-lymphocyte ratio [PLR], neutrophil-lymphocyte ratio [NLR], monocyte-lymphocyte ratio [MLR], systemic immune inflammation index [SII], and system inflammation response index [SIRI]) in patients with acute coronary syndrome (ACS).Methods: A total of 1,701 ACS patients who underwent percutaneous coronary intervention (PCI) were included in this study and followed up for major adverse cardiovascular events (MACE) including all-cause death, non-fatal ischemic stroke, and non-fatal myocardial infarction. The five indices were stratified by the optimal cutoff value for comparison. The association between each of the lymphocyte-based inflammatory indices and MACE was assessed by the Cox proportional hazards regression analysis.Results: During the median follow-up of 30 months, 107 (6.3%) MACE were identified. The multivariate COX analysis showed that all five indices were independent predictors of MACE, and SIRI seemingly performed best (Hazard ratio [HR]: 3.847; 95% confidence interval [CI]: [2.623–5.641]; p < 0.001; C-statistic: 0.794 [0.731–0.856]). The addition of NLR, MLR, SII, or SIRI to the Global Registry of Acute Coronary Events (GRACE) risk score, especially SIRI (C-statistic: 0.699 [0.646–0.753], p < 0.001; net reclassification improvement [NRI]: 0.311 [0.209–0.407], p < 0.001; integrated discrimination improvement [IDI]: 0.024 [0.010–0.046], p < 0.001), outperformed the GRACE risk score alone in the risk predictive performance.Conclusion: Lymphocyte-based inflammatory indices were significantly and independently associated with MACE in ACS patients who underwent PCI. SIRI seemed to be better than the other four indices in predicting MACE, and the combination of SIRI with the GRACE risk score could predict MACE more accurately.

Periprocedural heparin bridging therapy aims to reduce the risk of thromboembolic events in patients requiring an interruption in their anticoagulation therapy for the purpose of an elective procedure. The efficacy and safety of heparin bridging therapy has not been well established. To compare through meta-analysis the effects of heparin bridging therapy on the risk of major bleeding and thromboembolic events of clinical significance among patients taking oral anticoagulants. We searched PubMed, EMBASE and the Cochrane library from January 2005 to July 2016. Studies were included if they reported clinical outcomes of patients receiving heparin bridging therapy during interruption of oral anticoagulant for operations. Data were pooled using random-effects modeling. A total of 25 studies, including 6 randomized controlled trials and 19 observational studies, were finally included in this analysis. Among all the 35,944 patients, 10,313 patients were assigned as heparin bridging group, and the other 25,631 patients were non-heparin bridging group. Overall, compared with patients without bridging therapy, heparin bridging therapy increased the risk of major bleeding (OR = 3.23, 95%CI: 2.06–5.05), minor bleeding (OR = 1.52, 95%CI: 1.06–2.18) and overall bleeding (OR = 2.83, 95%CI: 1.86–4.30).While there was no significant difference in thromboembolic events (OR = 0.99,95%CI: 0.49–2.00), stroke or transient ischemic attack(OR = 1.45, 95%CI: 0.93–2.26,) or all-cause mortality (OR = 0.71, 95%CI: 0.31–1.65). Heparin-bridging therapy increased the risk of major and minor bleeding without decreasing the risk of thromboembolic events and all cause death compared to non-heparin bridging.

Background and Aims. Heart rate (HR) and hypertension are both important risk factors for adverse cardiovascular (CV) events in patients with established coronary artery disease (CAD). We sought to evaluate whether hypertension can modify the effect of admission HR on adverse CV events in patients with acute coronary syndrome (ACS). Methods. A total of 1056 patients with ACS undergoing percutaneous coronary intervention (PCI) were analyzed. All patients were classified into three groups according to the tertiles of admission HR (T1: ≤66 bpm, n = 369; T2: 67–73 bpm, n = 322; and T3: ≥74 bpm, n = 365). The primary endpoint was defined as major adverse CV events (MACEs), including all-cause death, stroke, myocardial infarction, or unplanned repeat revascularization. The multivariate Cox regression model was performed to evaluate the association of admission HR with MACE stratified by hypertension. Results. During the median follow-up of 30 months, a total of 232 patients developed at least one event. After adjusting for other covariates, elevated admission HR was significantly associated with an increased risk of MACE only in patients with hypertension (when T1 was taken as a reference, the adjusted HR of T2 was 1.143 [95% CI: 0.700–1.864] and that of T3 was 2.062 [95% CI: 1.300–3.270]); however, in patients without hypertension, admission HR was not associated with the risk of MACE (when T1 was taken as a reference, the adjusted HR of T2 was 0.744 [0.406–1.364] and that of T3 was 0.614 [0.342–1.101]) ( for interaction). Conclusions. In patients with ACS undergoing PCI, the association of elevated admission HR with an increased risk of MACE was present in individuals with hypertension but not in those without hypertension. This finding suggests a potential benefit of HR control for ACS patients when they concomitantly have hypertension.

Background: To compare the surgical effects of coronary intervention through the transradial intervention (TRI) versus distal transradial intervention (dTRI) approach. Methods: From September 2020 to April 2021, 302 patients undergoing coronary artery angiography (CAG) or percutaneous coronary intervention in our hospital were retrospectively included. Patients were divided into the TRI group and dTRI group with 151 cases in each group. The technique features, lesion features, and cannulation process were compared between the two groups. Results: The number of patients who underwent CAG in the dTRI group (35.1%) was significantly greater compared with the TRI group (12.6%) (P < 0.01). The rates of triple vessel lesions, calcification lesions and chronic total occlusion lesions were increased in the TRI group compared with the dTRI group (P < 0.05). The average radial artery diameter (RAD) in the TRI group (2.550 ± 0.417 mm) was greater than that in the dTRI group (2.070 ± 0.360 mm) (P < 0.05). The hemostasis time of the dTRI group (173.272 ± 41.807 min) was lower than that of the TRI group (273.417 ± 42.098 min) (P < 0.05). The radial artery occlusion (RAO) rates in the dTRI group (2.6%) were lower than those in the TRI group (8.6%) (P < 0.05). The dTRI group had a higher satisfaction score than the TRI group (P > 0.05). RAD at the puncture site was a predictor of the overall cannulation success rate with an AUC of 0.747 (95% CI 0.663–0.860; P < 0.05). Conclusions: Despite a steep learning curve, the dTRI approach had a shorter hemostasis time, reduced RAO rates, and notable preliminary safety results compared with the TRI approach. The dTRI approach can be used as a supplemental method to the TRI approach.

Background: Recently, the transcatheter aortic valve replacement (TAVR) indications have expanded; meanwhile, valve systems have continuously evolved and improved. However, coronary occlusion (CO), a rare but catastrophic consequence of TAVR surgery, limits the expansion of indications for TAVR. Moreover, comparisons between different systems remain scarce. This study aimed to evaluate the incidence of CO associated with TAVR, specifically comparing self-expanding valves (SEVs) and balloon-expandable valves (BEVs), and further assess the safety profile of these valve subtypes. Methods: The primary outcome of interest was the incidence of CO during TAVR using BEVs or SEVs. Electronic databases were searched from January 2009 to June 2023, and this study included randomized controlled trials, observational studies, and propensity pair-matched studies. Heterogeneity and inter-study variance were assessed using Cochran’s Q, I2, and τ2 (Sidik–Jonkman estimator). Random effects models were used based on the Bayesian theory framework. The node-splitting approach was generated to determine study network inconsistency. The convergence of the model was evaluated using the trajectory map, density map, and the potential scale reduction factor (PSRF). Rank sort graphs illustrate the best valve deployment techniques or valve types. Results: A total of 830 articles were searched referring to the incidence of CO using the valve deployment system of SEVs or BEVs during the TAVR procedure, from which 51 were included (27,784 patients). The procedure incidence of coronary obstruction was 0.4% for the SEVs and 0.6% for the BEVs. Treatment ranking based on network analysis revealed SAPIEN 3 (Edwards Lifesciences (Irvine, CA, USA)) possessed the best procedural CO incidence (0.05%) performance, whereas SAPIEN (Edwards Lifesciences (Irvine, CA, USA)) produced the worst (1.04%). Conclusions: Our study indicates that CO incidence was not reduced during TAVR with BEVs compared to SEVs. SAPIEN 3 and SAPIEN had the lowest and highest TAVR-associated CO rates, respectively. These findings suggest that the SAPIEN 3 valve may be the best choice for reducing CO risk, and future studies should focus on its applicability in different populations. More randomized controlled trials with head-to-head comparisons of SEVs and BEVs are needed to address this open question. The PROSPERO registration: CRD42024528269, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024528269.

Elevated stress hyperglycemia ratio (SHR) is a putative risk indicator for acute myocardial infarction (AMI). However, the relationship between SHR, albumin, and subsequent cardiovascular adverse outcomes is less well-established. We consecutively included patients from a multi-center, prospective registry (NCT05337319) from January 2022 to October 2023 and analyzed their baseline SHR and albumin levels. Low and high SHR were determined using the optimal cutoff value. The primary outcome was in-hospital major adverse cardiovascular events, which were composed of all-cause mortality, cardiac shock, acute congestive heart failure (ACHF), reinfarction, and stroke. Multivariable logistic regression models were used to estimate albumin-stratified associations between SHR and outcomes. A total of 5269 patients presenting with AMI were included, of which 27.7% were high-SHR and 19.5% had hypoalbuminemia. Low-SHR normalbuminemia had the lowest in-hospital MACEs (1.4%), with which as the reference, high-SHR hypoalbuminemia had the highest increase in MACEs (adjusted OR, 6.800; 95% CI, 3.883–11.907; P < 0.001), followed by low-SHR hypoalbuminemia (adjusted OR, 3.033; 95% CI, 1.775–5.182, P < 0.001), and high-SHR normalbuminemia (adjusted OR, 2.375; 95% CI, 1.335–4.226, P = 0.003). High-SHR was associated with increased cardiovascular risk regardless of baseline albumin level for MACEs (normalbuminemia: adjusted OR, 2.325; 95% CI, 1.307–4.136, P = 0.004; hypoalbuminemia: adjusted OR, 2.213; 95% CI, 1.343–3.647, P = 0.002; P = 0.866 for interaction), and cardiac shock or ACHF. Higher SHR is prevalent among patients with AMI, especially in those with hypoalbuminemia. Higher SHR was consistently associated with a more unfavorable in-hospital prognosis, regardless of their baseline albumin value.