Background and Objectives: The revascularization strategy for percutaneous coronary intervention (PCI) in patients with multivessel (MV) acute coronary syndrome (ACS) remains controversial. Certain gaps in the evidence are related to the optimal timing of non-culprit lesion revascularization and the utility of instantaneous wave-free ratio (iFR) in the management of MV ACS intervention. The major benefits of iFR utilization in MV ACS patients in one-stage complete revascularization are: (1) the possibility to virtually plan the PCI, both the location and the extension of the necessary stenting to achieve the prespecified final hemodynamic result; (2) the opportunity to validate the final hemodynamic result of the PCI, both in culprit artery and all non-culprit arteries and (3) the value of obliviating the uncomfortable, costly, time consuming and sometimes deleterious effects from Adenosine, as there is no requirement for administration. Thus, iFR use fosters the achievement of physiologically appropriate complete revascularization in MV ACS patients during acute hospitalization. Materials and Methods: This pilot study was aimed to test the feasibility of a randomized trial research protocol as well as to assess patient safety signals of co-registration iFR-guided one-stage complete revascularization compared with that of standard staged angiography-guided PCI in de novo patients with MV ACS. This was a single-center, prospective, randomized, open-label clinical trial consecutively screening patients with ACS for MV disease. The intervention strategy of interest was iFR-guided physiologically complete one-stage revascularization, in which the virtual PCI planning of non-culprit lesions and the intervention itself were performed in one stage directly following treatment of the culprit lesion and other critical stenosis of more than ninety percent. Seventeen patients were recruited and completed the 3-month follow-up. Results: Index PCI duration was significantly longer while the volume of contrast media delivered in index PCI was significantly greater in the iFR-guided group than in the angiography-guided group (119.4 ± 40.7 vs. 47 ± 15.5 min, p = 0.004; and 360 ± 97.9 vs. 192.5 ± 52.8 mL, p = 0.003). There were no significant differences in PCI-related major adverse cardiovascular events (MACE) between the groups during acute hospitalization and at 3-months follow-up. One-stage iFR-guided PCI requires fewer PCI attempts until complete revascularization than does angiography-guided staged PCI. Conclusions: Complete revascularization with the routine use of the virtual planning tool in one-stage iFR-guided PCI is a feasible practical strategy in an everyday Cath lab environment following the protocol designed for the study. No statistically significant safety signals were documented in the number of PCI related MACE during the 3-month follow-up.

Background: Recurrence prevention after Atrial Fibrillation (AF) termination by Eelectrical Cardioversion (ECV) remains challenging. Increasing attention is paid to pathophysiological effects of non-Antiarrhythmic Drugs (non-AADs), nevertheless, with heterogeneous results. Objective: We evaluated the potential benefits of different non-AADs as adjunctive therapy to Antiarrhythmic Drugs (AADs) for AF recurrence prevention after sinus rhythm restoration by ECV in high-risk patients. Methods: The study was conducted among high-risk AF patients after successful ECV. Prescription of class IC or class III AAD was required. Data were acquired in a face-to-face baseline interview and 1-, 3-, 6-, 9-, 12-month follow-up interviews. Results: 113 patients were included. Total AF recurrence rate reached 48.7%. Angiotensin-Converting Enzyme Inhibitor (ACEI) or angiotensin receptor blocker (ARB) intake, compared with non-use, demonstrated AF recurrence rate reduction by 8.5% (46.3 vs. 54.8%), with odds ratio (OR) reduced by 28.9% (OR 0.711, 95% confidence interval (CI) 0.310-1.631, p = 0.420). Among mineralocorticoid receptor antagonist (MRA) users, AF recurrence rate was reduced by 25.1% (29.6 vs. 54.7%) and OR by 65.1% (OR 0.349, 95%CI 0.138-0.884, p = 0.023). Present statin therapy reduced AF recurrence rate by 4.2% (46.8 vs. 51.0%) and OR by 15.5% (OR 0.845, 95%CI 0.402-1.774, p = 0.656). Diuretic use showed reduction of AF recurrence rate by 10.2% (41.7 vs. 51.9%) and OR by 33.9% (OR 0.661, 95%CI 0.297-1.469, p = 0.308). Conclusion: Non-AADs demonstrated practical benefits as adjunctive therapy to AADs for AF recurrence prevention after ECV in high-risk patients, with statistically significant results established for concomitant MRA intake.

Introduction: Insufficient statin/ezetimibe effectiveness for low-density lipoprotein cholesterol (LDL-C) reduction is not uncommon. A novel gene-silencing medication inclisiran has been introduced. Near-infrared spectroscopy (NIRS) allows to assess the dynamics of plaque lipid content in the context of optimal lipid-lowering pharmacotherapy. The aim of this study was to evaluate the impact of optimal hypolipidaemic pharmacotherapy, including add-on inclisiran, on the plasma lipid profile and plaque lipid content. Methods: This study enrolled patients with stable coronary artery disease, admitted for elective percutaneous coronary intervention (PCI). NIRS of the segment of interest was performed during index PCI and 15 months later. Patients having LDL-C >1.8 mmol/L after 4–6 weeks of maximum tolerated statin/ezetimibe therapy received add-on inclisiran. Lipid profile changes within 15 months were also evaluated. Results: Among 42 included patients, 24 drug-resistant hypercholesterolaemia participants were assigned to inclisiran therapy. After 15 months, a significant LDL-C decrease of 26.42% was established (p = 0.006), with 12 participants reaching the LDL-C goal of <1.8 mmol/L. Average 15-month LDL-C reduction was 36.03%. NIRS data demonstrated a significant reduction in maximum lipid-core burden index within 4 mm (maxLCBI4 mm) in the inclisiran group (−117.64, p = 0.004) and statin/ezetimibe group (−141.88, p = 0.004), with no significant difference between the groups (p = 0.213). Conclusion: Results demonstrate an association between better LDL-C control and coronary plaque lipid burden reduction. Addition of inclisiran leads to remarkable LDL-C reduction in patients who have run out of statin and ezetimibe treatment options.

Unsaturated fatty acids have the potential to reduce residual cardiovascular risk. Sea buckthorn (Hippophae rhamnoides L.) contains several valuable bioactive substances, including lipids with a balanced fatty acid composition. The aim of this study was to evaluate the effects of sea buckthorn seed lipid extract (SBS-LE) on residual cardiovascular risk in high-risk patients. In this pilot study, 86 patients with chronic coronary syndrome receiving statin (atorvastatin or rosuvastatin) and/or ezetimibe were enrolled. SBS-LE capsules (1000 mg, twice daily) were prescribed in addition to standard medical therapy, with each capsule containing 300 mg of omega-3 alpha-linolenic acid, 370 mg of omega-6 linoleic acid, 170 mg of omega-9 oleic acid and 7 mg of the plant sterol beta-sitosterol. For this clinical trial, SBS-LE was produced via supercritical fluid extraction with carbon dioxide. Clinical effects and impacts on laboratory test results were evaluated at baseline and after three months. Additionally, lipidomics testing was performed to confirm the bioavailability of the formulation. Significant reductions in systolic blood pressure by 2.9 mmHg (2.1%, p = 0.012), LDL-C by 0.3 mmol/l (12.0%, p = 0.005) and CRP by 1.0 mg/l (37.0%, p = 0.032) were observed. These data suggest that SBS-LE may have potential as an add-on preventive strategy for residual cardiovascular risk reduction.

Background and Objectives: Cigarette smoking remains a leading modifiable cardiovascular risk factor. This study aimed to analyze decade trends in daily smoking prevalence and its association with education level and physical activity by gender and age groups in Latvia. Materials and Methods: We analyzed data from two distinct waves of a population-based cross-sectional study conducted in Latvia. The study included a stratified random sample of adults aged 25–74 (N = 3807 in 2009; N = 4070 in 2019). Smoking status and education level were self-reported in both years; physical activity data were collected only in 2019. Multivariable logistic regression identified independent factors associated with smoking. Results: From 2009 to 2019, smoking prevalence decreased among men (from 43.6% to 36.0%, p < 0.01) and increased among women (from 15.0% to 18.1%, p < 0.01). Men and women with higher education were significantly less likely to be daily smokers (2019, Men: odds ratio (OR): 0.48, 95% confidence interval (CI) 0.38–0.59; Women: OR: 0.39, 95% CI 0.29–0.50). Among men, the proportion of daily smokers was higher in physically inactive (39.8%) and active (39.0%) groups compared to the moderately active group (31.4%, p < 0.01). However, physical activity level was not a significant predictor of smoking in the multivariable analysis. Conclusions: Over the decade, daily smoking prevalence decreased in men but increased in women in Latvia, with education level being a strong independent predictor. Although the proportion of smokers among men differed across physical activity groups, this factor was not an independent predictor of smoking. These findings underscore the need for targeted public health interventions in Latvia, specifically focusing on individuals with lower education levels to reduce the long-term cardiovascular burden.

Background: Elevated triglycerides have been established as a cardiovascular risk marker and the literature suggests an association with lipid-rich plaques. We report a case of severe hypertriglyceridaemia that did not result in lipid-rich atherosclerotic lesions. Case summary: Coronary angiography of a 54-year-old man with a triglyceride level >113.00 mmol/L revealed severe multivessel disease. Near-infrared spectroscopy (NIRS) demonstrated a low plaque lipid content, including the maximum lipid-core burden index within 4 mm of 0 in the right coronary artery (RCA), with >90% stenosis in the middle segment. To achieve a rapid reduction in the triglyceride level, intravenous administration of insulin and heparin combined with subsequent plasmapheresis was used, and a triglyceride level of 5.79 mmol/L was achieved before discharge. Genetic testing confirmed familial hypertriglyceridaemia with a pathogenic variant in the lipoprotein lipase gene. Conclusions: In a patient with severely elevated serum triglycerides and premature three-artery disease, low plaque lipid content was established with the NIRS investigation. Pharmacological management of very severe hypertriglyceridaemia with intravenous insulin and heparin therapy can rapidly decrease triglyceride levels.