Background/aim: The level of nitric oxide (NO) is important to protect the heart from ischemic damage in acute coronary syndrome (ACS) patients. S-nitrosothiol (SNO) is a molecule that represents the main form of NO storage in the vascular structure. In addition, dynamic thiol/disulfide homeostasis (TDH) is known to play an important role in maintaining the oxidant-antioxidant balance. In this study, our aim is to evaluate the oxidative/nitrosative stress status according to SNO level and TDH in patients with ACS. Materials and methods: The study included 124 patients who were admitted to the emergency service and 124 consecutive individuals who applied to the cardiology outpatient clinic with cardiac complaints and underwent coronary angiography (CAG). Blood was drawn from all participants included in the study to determine SNO, nitrite, total thiol, native thiol, and disulfide levels after 12 h of fasting. Results: Serum SNO levels were found to be significantly lower in ACS patients compared to the control group (0.3 ± 0.08 vs. 0.4 ± 0.10 µmol/L, successively, p < 0.001). In addition, while the total thiol, native thiol, and native thiol/total thiol levels were lower in the patient group compared to the control group, nitrite, disulfide/native thiol and disulfide/total thiol levels were higher. As a result of multivariate logistic regression analysis, it was determined that age, gender, smoking, low-density lipoprotein cholesterol, glycosylated haemoglobin, and SNO levels were independent predictors in predicting ACS patients. Conclusion: S-nitrosothiol and thiol levels were found to be significantly lower in ACS patients. In addition, SNO molecule was independently associated with the presence of ACS diagnosis.

Analyzing the local pericardial fluid (PF) surrounding the heart can provide insights into the function of myocardial and pericardial epithelial cells. Kynurenine (KYN) metabolites have been associated with endothelial dysfunction and the progression of atherosclerosis. This study investigated the relationship between KYN pathway metabolites in serum and PF and the severity of coronary atherosclerosis, as assessed by the Syntax Score (SS). The study involved 101 patients (mean age: 60 years). Of the participants, 17% were female. KYN and its metabolite levels were measured using API SCIEX 3200 LC-MS/MS methods. Statistical analysis was performed using IBM SPSS 25.0. The mean serum levels of tryptophan (TRP), 3-hydroxykynurenine (3-HK), and 3-hydroxyanthranilic acid were significantly higher (p < 0.01) when compared to the mean PF levels. In the SS-low group, PF IDO activity was significantly higher than serum IDO activity (p = 0.040). In the SS-high group, PF IDO activity was significantly higher than serum IDO activity (p = 0.002). The mean 3-HK measurements showed significant differences between the SS groups (p < 0.05). In this study, higher IDO enzyme activity in the PF compared to systemic circulation suggests the presence of inflammatory activity in the pericardial endothelial cells. This research aimed to uncover the role of amino acid metabolism, which is poorly understood in atherosclerosis. Specifically, 3-HK, a metabolite from the KYN pathway, may contribute to the development of atherosclerosis. These findings indicate that localized kynurenine pathway activation in the PF may contribute to coronary atherosclerosis, highlighting its potential as a biomarker or therapeutic target.

Background/Objectives: Real-world data comparing treatment strategies and in-hospital outcomes across no index revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) in NSTEMI patients remain limited. Methods: In this single-center retrospective cohort study, 1906 NSTEMI patients undergoing coronary angiography were categorized into no index revascularization (n = 946), PCI (n = 709), or CABG (n = 251) groups. The primary endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, cardiac arrest requiring cardiopulmonary resuscitation, sustained ventricular tachycardia/ventricular fibrillation, dialysis-requiring acute kidney injury, or stroke. Missing data were handled using multiple imputation with chained equations (MICE), and propensity score-based inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Results: In-hospital MACE was higher in the no index revascularization group than in the PCI and CABG groups (9.8% vs. 3.5% vs. 4.8%; p < 0.001). Patients managed with no index revascularization were older and had a greater comorbidity burden, lower left ventricular ejection fraction, and more frequent Killip class ≥ 2. In the primary multivariable model, chronic kidney disease, Killip class ≥ 2, lower LVEF, CRP, and male sex were associated with in-hospital MACE, whereas neither PCI nor CABG strategy was independently associated with MACE. IPTW sensitivity analyses yielded similar directions of association; however, the PCI estimate crossed the conventional significance threshold after 1st–99th percentile weight truncation. Conclusions: Patients managed with no index revascularization had a higher baseline risk profile and higher unadjusted in-hospital MACE and mortality. The observed between-group differences should be interpreted as associations rather than causal effects of treatment strategy because of substantial confounding by indication.

Background/Objectives: Every hour of delay in treating acute aortic dissection (AAD) increases mortality by 1–2%, underscoring the critical need for rapid identification of high-risk patients. Despite advances in surgical management, in-hospital mortality remains substantial, and early, reliable risk stratification tools are urgently needed. We targeted to assess the relationship between the De Ritis ratio (DRr) and in-hospital mortality in patients experiencing surgery for AAD. Methods: In this single-center retrospective study, 182 patients who underwent surgery for AAD between 2020 and 2025 were included. Demographic, clinical, laboratory, and echocardiographic data were analyzed. Receiver operating characteristic analysis was used to estimate the DRr’s discriminatory ability, and univariable and multivariable logistic regression analyses were utilized to find predictors of in-hospital mortality. Results: In-hospital mortality occurred in 59 patients (32.4%). When comparing survivors to non-survivors, the DRr was noticeably greater. Along with age, lactate level, and ejection fraction, the DRr continued to be an independent predictor of in-hospital mortality in multivariable analysis. Receiver operating characteristic analysis showed moderate discriminatory performance of the DRr, with an area under the curve of 0.701 and an optimal cut-off value of 1.308. Conclusions: The DRr is a practical and accessible biomarker related to in-hospital mortality in surgically treated AAD and may provide incremental prognostic value when used alongside established clinical and laboratory parameters.

Background/Objectives: Transaxillary access (TAx) is an established alternative to transfemoral access (TF) for transcatheter aortic valve implantation (TAVI) in patients with unfavorable iliofemoral anatomy. While TAx-TAVI has been increasingly adopted at experienced centers, propensity score-matched comparative data with VARC-3 endpoint definitions are scarce, and most existing series originate from Western European cohorts. We aimed to address this gap by reporting outcomes from a propensity-matched TAx versus TF cohort using VARC-3 endpoints, contributing contemporary data from a high-volume Turkish center with established alternative access expertise. Methods: Among 2389 consecutive TAVI procedures screened between January 2016 and December 2024, 291 patients with complete data were included. After stratification by access route (TAx n = 51; TF n = 240) and exclusion of one TAx patient with missing covariates, 1:2 greedy nearest-neighbor propensity score matching was performed using nine covariates. The final cohort comprised 150 patients (50 TAx, 100 TF). All outcomes were defined per VARC-3 criteria. Results: All nine covariates achieved standardized mean differences <0.1 after matching. Technical success was comparable (TAx 94.0% vs. TF 96.0%; p = 0.686). The VARC-3 early safety event rate did not differ significantly (16.0% vs. 15.0%; p = 1.000); no equivalence can be inferred given the small event counts and wide confidence intervals. Any bleeding (VARC-3) was significantly lower in the TAx group (8.0% vs. 22.0%; OR 0.31, 95% CI 0.10–0.95; p = 0.039), confirmed by conditional logistic regression for the matched structure (OR 0.32 [0.10–0.97]; p = 0.043); this should be considered an exploratory finding. Thirty-day all-cause mortality (encompassing in-hospital deaths) (6.0% vs. 10.0%; p = 0.545), 1-year mortality (12.0% vs. 16.0%; p = 0.628), and Kaplan–Meier 1-year survival (88.0% vs. 84.0%; log-rank p = 0.510) did not differ significantly. ICU stay (median 2 [1–2] vs. 2 [1–3] days; p = 0.020) and hospital stay (median 5 [4–6] vs. 5 [4–6] days; p = 0.005) yielded statistically significant p-values; however, medians were identical in both comparisons, and significance was driven by outlier-prolonged admissions in the TF group rather than a meaningful difference in typical recovery duration. Conclusions: TAx-TAVI demonstrated comparable mortality, safety, and hemodynamic outcomes to TF-TAVI, with a significantly lower rate of bleeding complications. Axillary access represents a safe and effective alternative route in patients unsuitable for transfemoral TAVI.

Prompt diagnosis and timely reperfusion are essential in ST-segment elevation myocardial infarction (STEMI). Large language models, such as ChatGPT, may as