Background: Contrast‐induced acute kidney injury (CI‐AKI) is one of the most serious complications in patients who undergo percutaneous coronary intervention (PCI), especially in those with acute coronary syndrome. It has been shown that inflammation may play an important role in the pathophysiology of CI‐AKI.Hypothesis: Inflammatory factors may play a predominant role in the prediction of CI‐AKI in patients who undergo emergency PCI.Methods: Patients who underwent emergency PCI from 2013 to 2015 were consecutively enrolled and were divided into CI‐AKI and non–CI‐AKI groups. Logistic analysis was used to identify the risk factors of CI‐AKI. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve (AUC) and to establish the optimal cutoff.Results: A total of 1061 patients were included, and the CI‐AKI rate was 5.47% (58/1061). Logistic analysis showed that the white blood cell (WBC) count (odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.018‐1.195, P = 0.016), neutrophil (N) count (OR: 1.134, 95% CI: 1.045‐1.232, P = 0.003), neutrophil to lymphocyte ratio (NLR) (OR: 1.105, 95% CI: 1.044‐1.169, P = 0.001), C‐reactive protein (CRP) level (OR: 1.006, 95% CI: 1.001‐1.011, P = 0.020), high‐sensitivity C‐reactive protein (hs‐CRP) level (OR: 1.099, 95% CI: 1.020‐1.184, P = 0.013), and big endothelin‐1 (ET‐1) level (OR: 4.030, 95% CI: 1.989‐8.165, P < 0.001) were all significant predictors for CI‐AKI, as was the left ventricular ejection fraction and diuretic administration. The AUC of the big ET‐1 level was the highest (0.793, 95% CI: 0.733‐0.853), followed by the NLR (0.708, 95% CI: 0.641‐0.774), hs‐CRP level (0.705, 95% CI: 0.627‐0.782), CRP level (0.684, 95% CI: 0.607‐0.761), N count (0.655, 95% CI: 0.584‐0.726), WBC count (0.620, 95% CI: 0.544‐0.695), and erythrocyte sedimentation rate (0.611, 95% CI: 0.527‐0.695).Conclusions: The WBC count, N count, NLR, CRP level, hs‐CRP level, and big ET‐1 level are all associated with an increased risk of CI‐AKI, and among which, the big ET‐1 level, NLR, and the hs‐CRP level might have high predictive value for CI‐AKI after an emergency PCI.

Objectives: To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). Design: Systematic review and meta-analysis of contemporary available evidence. Setting: PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0. Participants: Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included. Primary and secondary outcome measures: The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up. Results: A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I ² =77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I ² =77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I ² =39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I ² =74.5%). Conclusions: An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.

This study aimed to investigate the long-term biocompatibility, safety, and degradation of the ultrathin nitrided iron bioresorbable scaffold (BRS) in vivo, encompassing the whole process of bioresorption in porcine coronary arteries. Fifty-two nitrided iron scaffolds (strut thickness of 70 μm) and 28 Vision Co–Cr stents were randomly implanted into coronary arteries of healthy mini-swine. The efficacy and safety of the nitrided iron scaffold were comparable with those of the Vision stentwithin 52 weeks after implantation. In addition, the long-term biocompatibility, safety, and bioresorption of the nitrided iron scaffold were evaluated by coronary angiography, optical coherence tomography, micro-computed tomography, scanning electron microscopy, energy dispersive spectrometry and histopathological evaluations at 4, 12, 26, 52 weeks and even at 7 years after implantation. In particular, a large number of struts were almost completely absorbed in situ at 7 years follow-up, which were first illustrated in this study. The lymphatic drainage pathway might serve as the potential clearance way of iron and its corrosion products.

Background: To overcome the drawbacks of permanent stents, biodegradable stents have been studied in recent years. The bioabsorbable polymer vascular scaffold (BVS) was the first bioabsorbable stent to undergo clinical trials, demonstrating safety and feasibility in the ABSORB studies. Iron can potentially serve as the biomaterial for biodegradable stents. This study aimed to assess the short-term safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries. Methods: Eight iron stents and eight cobalt chromium alloy (VISION) control stents were randomly implanted into the LAD and RCA of eight healthy mini-swine, respectively. Two stents of the same metal base were implanted into one animal. At 28 days the animals were sacrificed after coronary angiography, and histopathological examinations were performed. Results: Histomorphometric measurements showed that mean neointimal thickness ((0.46±0.17) mm vs. (0.45±0.18) mm, P=0.878), neointimal area ((2.55±0.91) mm² vs. (3.04±1.15) mm², P=0.360) and percentage of area stenosis ((44.50±11.40)% vs. (46.00±17.95)%, P=0.845) were not significantly different between the iron stents and VISION stents. There was no inflammation, thrombosis or necrosis in either group. The scanning electron microscopy (SEM) intimal injury scores (0.75±1.04 vs. 0.88±0.99, P=0.809) and number of proliferating cell nuclear antigen (PCNA) positive staining cells were not significantly different between the two groups. The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents ((84.38±14.50)% vs. (65.00±22.04)%, P=0.057), but the difference was not statistically significant. Iron staining in the tissue surrounding the iron stents at 28 days was positive and the vascular wall adjacent to the iron stent had a brownish tinge, consistent with iron degradation. No abnormal histopathological changes were detected in coronary arteries or major organs. Conclusions: The biodegradable iron stent has good biocompatibility and short-term safety and efficacy in the miniswine coronary artery. Corrosion of iron stents is observed at four weeks and no signs of organ toxicity related to iron degradation were noted.

The aim of this study was to evaluate and compare the usefulness of the C-reactive protein (CRP)-triglyceride glucose (TyG) index (CTI) and other insulin resistance (IR) or inflammatory indexes for predicting recurrent cardiovascular events in percutaneous coronary intervention (PCI)—treated patients. In addition, the mediating effects of systemic inflammation, represented by high-sensitive CRP (hs-CRP), on TyG index-associated adverse cardiovascular events across different subgroups were also evaluated. The formula for calculating the CTI was 0.412 × ln [high-sensitivity CRP (mg/L)] + ln [triglyceride (mg/dl) × fasting glucose (mg/dl)/2]. The primary endpoint was defined as the incidence of major adverse cerebrovascular and cardiovascular events (MACCEs), including cardiovascular death, nonfatal acute myocardial infarction (AMI), nonfatal ischemic stroke and repeat coronary revascularization. Among the 2383 PCI-treated patients, 413 experienced MACCEs during a median of 34 months follow-up. Correlation analysis showed CTI was significantly associated with cardiometabolic factors. The CTI was the strongest predictor for MACCEs (adjusted HR 1.85, 95% CI 1.44–2.38) among the inflammatory and IR indicators. CTI had an incremental effect on the predictive ability of the prognostic model for MACCEs (NRI: 0.220, p < 0.001; IDI: 0.009, p < 0.001). Subgroup analysis revealed that the prognostic value of the CTI remained significant across all subgroups (all p < 0.05) whereas the predictive abilities of other IR or inflammatory indicators were more or less influenced by the metabolic abnormalities. Finally, mediation analysis revealed that the effects of systemic inflammation on TyG index—associated MACCEs were more prominent in patients with metabolic disorders. CTI was a practical indicator for evaluating cardiometabolic diseases. Among the IR and inflammatory indicators, CTI was the most promising index for predicting recurrent cardiovascular risks in PCI-treated patients. TyG index—associated cardiovascular risks were partially mediated by systemic inflammation in patients with metabolic abnormalities.