Background: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (n = 230) with LM disease either treated by PCI (n = 118) or CABG (n = 112). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction (MI), stroke, and target vessel revascularization (TVR) for 7 years. Results: In the multivariate-adjusted analysis, the presence of intermediate EuroSCORE II and high SYNTAX scores predisposed to CABG. Isolated LM disease was associated with receiving PCI. The PCI group had a similar rate of MACE (HR_adj 0.97, 95% CI [0.48–1.94], p = 0.92) and a lower tendency of hard MACE (HR_adj 0.49, 95% CI [0.22–1.07], p = 0.07) compared to the CABG group, mainly due to the balance between a higher rate of TVR (HR_adj 9.71, p = 0.02) and a lower rate of stroke (HR_adj 0.22, p = 0.09) with the PCI group than in the CABG group. Conclusions: The decision making of treatment strategy was made based on clinical and angiographic factors. The selected patients who received PCI showed similar MACE and trend of a lower rate of composite hard endpoints despite multivariate adjustment.

Blood type is reportedly correlated with the occurrence of cardiovascular diseases, presumably because of its effect on thrombogenicity. However, the relationship between blood type and thrombotic complications in atrial fibrillation (AF) remains unclear. This retrospective study analyzed the blood types of 1170 AF patients (mean age, 70 years; 58% men) who were followed up for up to 4 years. Patients with greater than mild mitral stenosis or prosthetic valves were excluded. The cohort included 305 (26%) type O, 413 (35%) type A, 333 (28%) type B, and 119 (10%) type AB patients. The primary endpoint of major adverse cerebrovascular events (MACE) occurred in 52 (4.4%) patients. When longitudinal outcomes were plotted, AB blood type patients had worse prognosis than non-AB blood type patients (p = 0.039), particularly type O blood patients (p = 0.049). Multivariate Cox regression analysis revealed that AB blood type was associated with higher MACE rates (adjusted hazard ratio, 2.01; 95% confidence interval, 1.01–4.00; p = 0.048) than non-AB blood types independent of anticoagulation therapy duration or CHA2DS2-VASc score. These indicate that AF patients with AB blood type are at an increased risk of MACE compared to those with non-AB blood type independent of the duration of anticoagulation or the CHA₂DS₂-VASc score.

Background and Objectives: The benefits of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among high-risk patients with diabetes are controversial owing to bleeding risk. Current guidelines recommend the use of aspirin in high-risk patients with diabetes; however, the supporting evidence is inconsistent, primarily due to an increased risk of gastrointestinal (GI) bleeding. Given these concerns, it is important to explore alternative antiplatelet strategies. Clopidogrel, a widely used P2Y12 inhibitor, has been suggested to cause fewer GI bleeding events than aspirin. Accordingly, we aimed to compare the efficacy and bleeding risk of clopidogrel versus aspirin in high- and very high-risk populations with diabetes without prior ASCVD using the Korean National Health Insurance Service data. Materials and Methods: Propensity score-matching was performed to reduce baseline imbalances. The primary endpoint was net adverse clinical events (NACEs), defined as a composite of all-cause death, myocardial infarction (MI), stroke, intracranial hemorrhage (ICH), and gastrointestinal GI bleeding. Secondary endpoints included efficacy (composite of all-cause death, MI, and stroke) and bleeding outcomes (GI bleeding and ICH). Results: Among 10,453 patients (9550 on aspirin and 903 on clopidogrel), 902 matched pairs were analyzed. Clopidogrel showed no significant difference compared with aspirin in NACE incidence (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.79–1.19), efficacy endpoints (HR: 1.02; 95% CI: 0.82–1.26), or individual outcomes (MI, stroke, all-cause death). Clopidogrel demonstrated a trend towards lower GI bleeding (HR: 0.48; 95% CI: 0.23–1.01), although not significant. In subgroup analysis, male patients on clopidogrel had significantly lower NACE risk than those on aspirin (HR: 0.73; 95% CI: 0.54–0.99). Conclusions: These findings suggest that clopidogrel may be considered a preferable alternative to aspirin for primary prevention in high-risk male patients with diabetes, particularly those with an elevated risk for gastrointestinal bleeding, guiding personalized antiplatelet therapy choices in clinical practice.

There are no data available comparing the real-world, long-term clinical outcomes of drug-eluting balloon (DEB) angioplasty and drug-eluting stent (DES) implantation in DES in-stent restenosis (ISR) lesions. We aimed to compare the real-world, long-term data available between DEBs and DESs in DES-ISR lesions. We analyzed consecutive DES-ISR lesions (225 lesions from 205 patients; male: 66.3%; mean age: 62.4 years) treated with either DEB or DES. The primary endpoint was target lesion revascularization (TLR), and the primary safety endpoint was the lesion-oriented composite outcome (LOCO). The LOCO is composed of cardiac death, myocardial infarction, and target lesion thrombosis during follow-up. During the 7-year follow-up period, TLR did not differ significantly between the DEB (n = 108) and the DES groups (n = 117) (HR: 1.07; 95% CI: 0.59–1.93, p = 0.83). The LOCO was significantly lower in the DEB group compared to the DES group (HR: 0.40; 95% CI: 0.16–0.98, p = 0.04), which was mainly driven by the lower levels of myocardial infarction (HR: 0.24; 95% CI: 0.06–0.94, p = 0.04) and the absence of target lesion thrombosis in the DEB group (vs. DES group 6%, p = 0.02). Additionally, cardiac death was found to be similar between the DEB and DES groups (HR: 0.56; 95% CI: 0.18–1.75, p = 0.32). DEB angioplasty showed favorable safety with a similar efficacy to that of DES implantation in DES-ISR lesions during the long-term follow-up period.

Background and Objectives: Polymer-free ultrathin strut sirolimus- and probucol-eluting stents (PF-SES) are recognized as safe and effective in diverse patient populations, although the implications of post-dilation during stent implantation remain underexamined. Materials and Methods: In this study, patients implanted with PF-SES at Gachon University Gil Medical Center between December 2014 and February 2018 were evaluated. Major adverse cardiovascular events (MACE), encompassing nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death were identified as primary outcomes, with secondary outcomes including target vessel revascularization (TVR), target lesion revascularization (TLR), and in-stent restenosis (ISR). Results: Of the 384 initial patients, 299 were considered eligible for analysis. The groups, delineated by those undergoing post-dilation (143 patients) and those not (156 patients), exhibited comparable rates of primary outcomes [hazard ratio (HR), 2.17; 95% confidence interval (CI), 0.40 to 11.87; p = 0.37]. The outcomes remained consistent irrespective of the post-dilation status and were similarly unaffected in multivariate analyses (HR, 2.90; 95% CI, 0.52 to 16.34; p = 0.227). Conclusions: These results suggest that the clinical outcomes of patients with post-dilation were similar to that of those without post-dilation in those with the polymer-free sirolimus- and probucol-eluting stents.