Search Results (105)

Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) often coexists with multivessel coronary artery disease (MVD), complicating treatment decisions. Current guidelines suggest complete revascularization (CR), yet robust evidence in hemodynamically stable patients remains insufficient. However, the comparative benefit of CR over incomplete revascularization (IR) in reducing ischemic events and improving cardiac function in this population is not well established. The aim of this study was to evaluate the impact of CR on all-cause mortality, cardiac death, and ischemic readmissions at 6 and 12 months, as the composite primary outcome, and to assess left ventricular ejection fraction (LVEF) improvement at discharge and hospital length of stay, as secondary outcomes. A total of 282 hemodynamically stable NSTE-ACS patients with MVD were included, of whom 218 (77.3%) underwent CR and 64 (22.7%) IR. The primary composite outcome occurred in 40.6% of IR patients versus 11.0% in the CR group at 6 months (p < 0.001), and 68.8% vs. 22.0% at 12 months (p < 0.001). CR was associated with significantly lower rates of all-cause and cardiac death, myocardial infarction, and unstable angina. Stroke incidence was similar. Event-free survival favored CR. Multivariable analysis identified CR and baseline LVEF as independent predictors of 12-month outcomes (HR for CR: 7.797; 95% CI: 3.961–15.348; p < 0.001; HR for LVEF: 0.959; CI: 0.926–0.994; p = 0.021). These findings strongly support CR as the preferred therapeutic strategy. Future prospective randomized studies are warranted to confirm the results. Full article

Background: The optimal revascularization strategy for patients with left main coronary artery (LMCA) disease has been repeatedly addressed in randomized controlled trials (RCTs), although outcomes from real-life clinical studies are still poorly investigated. Objectives: This retrospective study aimed to assess the complete 5-year outcomes for individuals with multivessel coronary artery disease (MVD) involving LMCA disease treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) as recommended by a local HT. Methods: From 2016 to 2019, 176 Heart Team (HT) meetings were held. Primary and secondary endpoints of 267 patients with MVD involving LMCA disease qualified either for CABG or PCI (109 and 158 patients, respectively) with subsequent optimal medical therapy (OMT) were assessed. The primary endpoint of the study was as an overall mortality, while secondary endpoints contained major adverse cardiac and cerebrovascular events (MACCE)—specifically, stroke, myocardial infarction (MI), repeat revascularization (RR), and the individual components of MACCE. Results: At 5 years, we found no significant difference in overall mortality between the both cohorts (22.9%-CABG vs. 24.7%-PCI, p = 0.74). The rate of MI was higher in patients treated percutaneously (7.3% vs. 15.8% for PCI, p = 0.04), while the incidence of stroke was higher in patients who underwent CABG (3.8% vs. 11.0% for CABG, p = 0.02). A MACCE occurrence was higher in PCI cohort (77.2% vs. 55.0%, p < 0.001), mainly driven by higher rates of RR was higher in patients treated percutaneously (32.9% vs. 13.8%, p < 0.001). Conclusions: For patients with LMCA disease, neither CABG nor PCI following HT decisions showed overwhelming superiority in real-life clinical practice: occurrence of all-cause death was similar, rates of MACCE, MI, and repeat revascularization advocated CABG, while incidence of strokes favored PCI. Full article

Background/Objectives: Heart failure (HF) with reduced ejection fraction (EF) has, in more than 50% of cases, an ischemic etiology and continues to be associated with increased mortality and morbidity despite all the progress registered in the field of medical therapy and interventional revascularization. Myocardial revascularization is extensively used in clinical practice based on the traditional concept that it can improve myocardial function and outcome in ischemic HF. This review is aimed at presenting current knowledge regarding revascularization in patients with chronic ischemic HF and reduced EF. Methods: The impact of revascularization on symptomatology, left ventricle reverse remodeling, major adverse cardiac events (MACEs), and the role of complete revascularization and of percutaneous interventional revascularization in chronic total occlusion (PCI-CTO) were analyzed. The best therapeutic strategies, revascularization and/or optimal medical therapy (OMT), are debated in different categories of patients, in order to identify who will benefit more from revascularization strategies. Results: Based on the long-term results of the STICH trial incorporated in the guidelines with a class I-b recommendation, coronary artery bypass graft (CABG) remains the main modality of revascularization for prognostic improvement in ischemic HF with multivessel disease. But real-life patients are usually old with multiple comorbidities and high surgical risk. In this category, the Heart Team opinion is required to evaluate the probability of complete revascularization and to choose between percutaneous coronary intervention (PCI) and CABG according to clinical status and coronary anatomy. Conclusions: However, until further studies are available, the results of the REVIVED-BCIS2 trial encourage OMT over PCI in patients with ischemic cardiomyopathy. The available randomized controlled trials (RCTs) showed improved angina and quality of life in PCI-CTO versus OMT, but the effect on MACEs was not demonstrated. Full article

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

Fractional flow reserve (FFR) is a standard physiological index for guiding coronary revascularization, with a threshold of >0.80 typically used to defer intervention. However, due to its distinct anatomical and physiological features, the left anterior descending artery (LAD) often exhibits lower FFR values than non-LAD vessels for lesions of similar angiographic severity. These vessel-specific differences raise concerns about applying a uniform FFR cutoff across all coronary territories. Observational studies indicate that LAD lesions deferred at an FFR of 0.80 may have similar or better outcomes than non-LAD lesions do. LAD lesions also tend to show lower post-percutaneous coronary intervention FFR values, suggesting that vessel specific target thresholds may be more prognostically appropriate. Additionally, some evidence suggests that instantaneous wave-free ratio may offer greater prognostic value than FFR, specifically in LAD lesions, a trend not consistently seen in other arteries. In patients with acute myocardial infarction and multivessel disease, the prognostic relevance of non-culprit lesion FFR may vary by coronary territory, particularly in the LAD. This review outlines the physiological rationale and clinical evidence for vessel-specific interpretation of FFR, with a focus on the LAD, and explores its potential clinical implications and limitations. Full article

Background: Patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who undergo complete revascularization (CR) have a more favorable prognosis than those who receive incomplete revascularization (IR), as evidenced by recent randomized controlled trials. Despite the absence of a survival benefit associated with CR in these trials, positive outcomes were ascribed to combined endpoints, such as repeat revascularization, myocardial infarction, or ischemia-driven rehospitalization. In light of the significant burden that rehospitalization from STEMI imposes on healthcare systems, we examined the long-term effects of CR on ischemia-driven rehospitalization and cardiovascular (CV) mortality in STEMI patients with MVD. Methods: In our retrospective study, we included patients with STEMI and MVD who underwent successful primary percutaneous coronary intervention (PCI) at the University Medical Centre Ljubljana between 1 January 2009, and 11 April 2011. The combined endpoint was ischemia-driven rehospitalization and CV mortality, with a minimum follow-up period of six years. Results: We included 235 participants who underwent CR (N = 70) or IR (N = 165) at index hospitalization, with a median follow-up time of 7 years (interquartile range 6.0–8.2). The primary endpoint was significantly higher in the IR group than in the CR group (47.3% vs. 32.9%, log-rank p = 0.025), driven by CV mortality (23.6% vs. 12.9%, log-rank p = 0.047), as there was no difference in ischemia-driven rehospitalization rate (log-rank p = 0.206). Ischemia-driven rehospitalization did not influence CV mortality in the CR group (p = 0.49), while it significantly impacted CV mortality in the IR group (p = 0.03). After adjusting for confounders, there were no differences in CV mortality between CR and IR groups (p = 0.622). Predictors of the combined endpoint included age (p = 0.014), diabetes (p = 0.006), chronic kidney disease (CKD) (p = 0.001), cardiogenic shock at presentation (p = 0.003), chronic total occlusion (CTO) (p = 0.046), and ischemia-driven rehospitalization (p = 0.0001). Significant risk factors for the combined endpoint were cardiogenic shock at presentation (p < 0.001), stage 4 kidney failure (p = 0.001), age over 70 years (p = 0.004), female gender (p = 0.008), and residual SYNTAX I score > 5.5 (p = 0.017). Conclusions: Patients with STEMI and MVD who underwent CR had a lower combined endpoint of ischemia-driven rehospitalizations and CV mortality than IR patients, but after adjustments for confounders, the true determinants of the combined endpoint and risk factors for the combined endpoint were independent of the revascularization method. Full article

Background/Objectives: Multivessel coronary artery disease (CAD) remains a challenging condition requiring multidisciplinary decision-making, particularly when determining between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Recent advancements in artificial intelligence (AI), particularly generative language models like ChatGPT, present an opportunity to assist in the decision-making process. However, their ability to replicate human clinical judgment in complex scenarios, such as multivessel CAD, remains untested. Methods: The aim of this study was to evaluate the concordance between recommendations from AI (ChatGPT) and those from heart team (HT) in the management of multivessel CAD, with a focus on comparing treatment strategies such as PCI and CABG. A retrospective observational study was conducted on 137 patients with multivessel CAD, discussed at multidisciplinary HT meetings in 2024. Standardized clinical vignettes, including clinical and anatomical data, were presented to ChatGPT for treatment recommendations. The AI’s responses were compared with the HT’s decisions regarding PCI or CABG. Statistical analysis was performed to assess the level of agreement and predictive value of ChatGPT’s recommendations. Results: ChatGPT achieved an overall accuracy of 65% in its recommendations. The agreement rate was higher for CABG (82.4%) than for PCI (44.4%). Discordance was identified in 48 patients, with a notable bias towards recommending CABG. Factors such as age, diabetes, and chronic kidney disease were predictors of discordance, although no significant factors emerged for the PCI or CABG subgroups. Conclusions: AI, particularly ChatGPT, demonstrated modest concordance with HT decisions in the management of multivessel CAD, especially favoring CABG. While AI offers potential as a decision-support tool, its current limitations highlight the continued need for human clinical judgment in complex cases. Further research is required to optimize AI integration into clinical decision-making frameworks. Full article

Objective: To evaluate the outcome of single vs. bilateral internal thoracic artery (SITA vs. BITA) revascularization in patients with multivessel coronary disease referred for coronary artery bypass graft (CABG) while on chronic dialysis. Methods: This retrospective analysis included all the patients with multivessel disease on chronic dialysis who underwent isolated CABG in our center during 1996–2021, utilizing SITA or BITA revascularization. We further matched the groups according to patient age and EuroSCORE II ±0.5. Results: Of the 7547 patients with multivessel disease who underwent CABG, 77 were on chronic dialysis. Of these, 2 had incomplete follow-up data, 58 underwent SITA, and 17 BITA revascularization. Comparing the SITA group with the BITA, the mean age was higher (67.8 vs. 58.6 years, standardized mean difference 1.035); the median (interquartile range) EuroSCORE II was higher (3.73 (1.78–6.23) vs. 1.78 (1.38–3.50), standardized mean difference 0.934); and comorbidities were more prevalent. Early mortality did not differ between the BITA and SITA groups in the unmatched cohort (11.8% vs. 15.5%, p > 0.999) or in the matched cohort (12.5% vs. 6.3%, p = 0.999). Other early adverse events such as early stroke, myocardial infarction, and bleeding requiring re-exploration were also similar. The median survival was 1.22 ± 0.5 years for the SITA and 5.64 ± 1.50 years for the BITA group. The respective five-year survival rates were 22.5 ± 5.9% and 58.35 ± 13.80%, p = 0.005. For the matched cohort, comprising 16 patient pairs, the five-year survival did not differ between the groups (27.8 ± 11.7% vs. 54.7 ± 14.7%, p = 0.258). In multivariable analysis, adjusted to EuroSCORE II and age, the hazard ratio (95% confidence interval) for BITA revascularization was insignificant, 0.638 (95% CI 0.25–1.62), p = 0.343. The hazard ratios for age and EuroSCORE II were 1.061 (95% CI 1.023–1.101), p = 0.002 and 1.155 (95% CI 1.070–1.246), p < 0.001. Conclusions: Despite a trend in favor of BITA utilization, no clear long-term survival benefit was demonstrated for BITA revascularization in patients on chronic dialysis after CABG. Full article

Multiple sclerosis (MS) is a chronic progressive neurodegenerative disease that leads to disabilities such as difficulty moving and slowed cognitive processing. It is the leading non-traumatic cause of disability worldwide. MS also has a high potential to become a model for neurodegenerative diseases with a progression like Alzheimer’s or Parkinson’s. Cardiovascular diseases (CVDs) remain the leading cause of global deaths and have a considerable economic impact. The higher incidence of cardiovascular comorbidities in patients with MS compared to healthy individuals of the same age worsens the prognosis of neurological pathology, leading to a higher level of disability, poorer physical outcomes, higher depression scores, cognitive aging, and diminished quality of life. Classical observational studies often have questionable elements that can represent a source of error, making it difficult to establish a causal relationship between MS and CVD. Genetic studies, including genome-wide evaluation, may resolve this issue and may represent a topic for future research. We report the case of a 31-year-old male patient with a history of multiple sclerosis (MS) diagnosed seven years prior, who presented with acute chest pain upon returning from vacation. Despite the previous recommendation for disease-modifying therapy, the patient had discontinued treatment by personal choice. Electrocardiography (ECG) revealed ST-segment elevation in inferior leads, and emergent coronary angiography identified severe multi-vessel coronary artery disease (CAD), requiring immediate revascularization. This case highlights the potential cardiovascular risks in young patients with MS and the importance of continuous medical supervision. Full article

Background: Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especially if associated with severe multiple coronary stenosis, increased pharmacological and/or mechanical support in the early post-CPB period is often required to support left ventricular recovery. In this study, we analyzed the results of a myocardial protection strategy that includes selective infusion of cardioplegia through each venous graft followed by warm reperfusion distal to each coronary anastomosis until complete removal of the aortic clamp (total antegrade cardioplegia infusion and warm reperfusion = TAWR) to improve early postoperative recovery in patients with depressed left ventricular function undergoing multi-vessel CABG. Methods: Out of 97 patients undergoing CABG using the TAWR strategy for myocardial protection, 32 patients presented with depressed left ventricle function (EF < 40%) and multi-vessel coronary diseases requiring ≥2 vein grafts and were enrolled as Group A. Combined primary outcomes and postoperative early and late left ventricle recovery (including spontaneous rhythm recovery, inotropic support and postoperative troponin release) were analyzed and compared with those of 32 matched patients operated on using standard antegrade root cardioplegia and limited warm reperfusion through LIMA graft (SAWR) enrolled as Group B. Results: Two patient died in hospital (in-hospital mortality 3.1%) with no statistical differences between the two groups. In Group A 27 patients (90%) had spontaneous recovery of idiopathic rhythm compared to 17 (53%) in group B (p = 0.001). Early inotropic support was required in nine patients (28%) of group A and seventeen patients (53%) of group B (p = 0.041). Furthermore, in eight patients (25%) of group A and seventeen (53%) of group B (p = 0.039) inotropic support was continued for >48 h. Conclusions: The TAWR strategy seems to significantly improve early postoperative cardiac recovery in patients with left ventricle depression undergoing multi-vessel CABG, when compared with SAWR strategy and could therefore be considered the strategy of choice in this subset of patients. Full article

Background/Objectives: In recent decades, shifting demographics and advancements in treating cardiovascular disease have altered the types of patients receiving coronary angiography (CA). However, data investigating the impact of kidney dysfunction stratified by the indication for CA are limited. Methods: Consecutive patients who underwent invasive CA at one institution between 2016 and 2022 were included in this study. Firstly, the prevalence and extent of coronary artery disease (CAD) in patients with different levels of kidney function was assessed. Secondly, the study examined how impaired kidney function affected long-term outcomes—specifically the risk of rehospitalization for heart failure (HF), acute myocardial infarction (AMI), or the need for coronary revascularization—at 36 months of follow-up. Results: A total of 7624 patients undergoing CA were included with a median estimated glomerular filtration rate (eGFR) of 68.9 mL/min/1.73 m² (IQR: 50.8–84.3). In total, 63.7% of patients had an eGFR ≥ 60 mL/min/1.73 m², 29.0% an eGFR of 30–<60 mL/min/1.73 m², and 7.3% an eGFR of <30 mL/min/1.73 m². Compared to patients with an eGFR ≥ 60 mL/min/1.73 m², those with an eGFR 30–<60 mL/min/1.73 m² and eGFR < 30 mL/min/1.73 m² had a higher prevalence of CAD (66.8% vs. 72.9% and 80.1%, respectively; p = 0.001) and three-vessel CAD (25.6% vs. 34.5% and 39.5%, respectively; p = 0.001). At 36 months of follow-up, patients with an eGFR 30–<60 mL/min/1.73 m² and eGFR < 30 mL/min/1.73 m² suffered from significantly higher risk of HF-associated rehospitalization (HR = 1.937, 95% CI: 1.739–2.157, p = 0.001 and HR = 3.223, 95% CI: 2.743–3.787, p = 0.001, respectively) and AMI compared to patients with an eGFR ≥ 60 mL/min/1.73 m² (reference group). The significantly higher risk of HF-related rehospitalization remained after multivariable adjustment. Conclusions: Both groups with impaired kidney function demonstrated a markedly higher risk of rehospitalization for HF at 36 months—even after multivariate adjustments. Increased risk of HF-related rehospitalization in patients with an eGFR < 30 mL/min/1.73 m² was especially evident if they also presented with decompensated HF and LVEF < 35%. In patients with an eGFR 30–<60 mL/min/1.73 m², presenting with angina pectoris and multivessel disease increased the risk of HF-related rehospitalization. Full article

Background/Objectives: Patients with coronary artery disease undergoing coronary artery bypass grafting (CABG) have a high prevalence of type 2 diabetes mellitus (T2DM) and prediabetes. Glucose metabolism disorders (GMDs) are often asymptomatic and remain undetected, but untreated they can have adverse effects. To evaluate the possibilities of active screening in identifying T2DM and prediabetes before CABG and to assess the impact of GMD on the incidence of postoperative complications. Methods: This study included 1021 patients who underwent CABG in 2016–2018 at the department of cardiovascular surgery, whose glycemic status was determined. All patients had their glycated hemoglobin (HbA1c) levels measured; those without a previous diagnosis of diabetes underwent an oral glucose tolerance test. The frequency of newly diagnosed diabetes and prediabetes was evaluated. Postoperative complication rates were analyzed among patient groups with various types of GMDs and normal blood glucose levels. Results: Screening before CABG increased the number of patients with established type 2 diabetes from 20.9 to 27.8% and the number of people with prediabetes from 2.7% to 31.7%. When analyzing hospital complications, patients with type 2 diabetes compared to patients with normoglycemia were significantly more likely to develop heart failure (p = 0.010), multiple organ failure (p = 0.002), require extracorporeal homeostasis correction (p = 0.011), and wound dehiscence (p = 0.004). Nine patients (0.9%) died following CABG without being discharged from the hospital, with 90% of these deaths occurring in patients with GMDs. Any GMD (diabetes or prediabetes) was associated with an increased incidence of postoperative heart failure (OR 1.259; p = 0.011), rhythm disturbances (OR 1.236; p = 0.010), major cardiovascular complications and/or heart failure (OR 1.193; p = 0.039), and all cardiovascular complications (OR 1.455; p = 0.002). In the presence of any GMD, the risk of multiple organ failure increased by 2.5 times (OR 2.506; p = 0.014), extracorporeal correction of homeostasis increased by 1.8 times (OR 1.821; p = 0.034), and diastasis of the wound edges increased by 1.3 times (OR 1.266; p = 0.005). It is important that, when adjusting for gender and age, the effect of GMD on the described complications remained significant. Conclusions: Active preoperative detection established an extremely high prevalence of GMD in patients with multivessel coronary artery disease (59.5%). T2DM and prediabetes are significant predictors of postoperative complications of coronary artery bypass grafting. Full article

The understanding of coronary artery disease is evolving, with more attention given currently to the microcirculation compartment. Coronary microvascular dysfunction (CMD) is defined by any structural or functional alteration of the coronary microcirculation, and is prevalent in current clinical practice, being associated with pejorative cardiovascular prognosis. CMD can exist by itself as primary microvascular angina, or in association with a variety of cardiovascular diseases. On the other hand, fractional flow reserve (FFR) represents the gold standard for estimating the hemodynamic impact of moderate coronary artery stenosis, and as such guiding coronary revascularization in clinical practice. The fundamental clinical trials that introduced and validated the use of FFR in current clinical practice were published before acquiring more in-depth knowledge on CMD and the impact it can have on FFR measurements. However, in the setting of CMD, studies have shown that FFR can underestimate the severity of coronary stenosis. In addition, recent findings underline the limitations of FFR to guide revascularization in terms of clinical outcome in specific conditions associated with CMD, such as acute coronary syndrome or multivessel coronary artery disease. As such, new research efforts must be made to investigate the reliability of FFR or to reposition its use in guiding coronary revascularization in the context of CMD, in order to define the clinical value of FFR in this particular setting. Full article

Background/Objectives: Severe obesity significantly increases the risk of complications following full sternotomy in coronary artery bypass grafting (CABG). However, these patients are frequently excluded from less invasive, sternum-sparing surgical alternatives. This study aimed to assess the safety and practicality of a newly developed technique—Total Coronary Revascularization via left Anterior miniThoracotomy (TCRAT)—that avoids sternotomy in patients with severe obesity requiring multivessel CABG. Methods: From November 2019 to May 2024, a total of 502 non-emergency patients with multivessel coronary artery disease underwent CABG through a left anterior minithoracotomy using cardiopulmonary bypass (CPB) and cardioplegic arrest. Of these, 43 patients with a body mass index (BMI) exceeding 35.0 kg/m² were classified as severely obese and included for subgroup analysis. Their outcomes were compared to those of the remaining 459 patients with BMI below 35.0 kg/m². Key intraoperative variables—such as total operative time, CPB duration, aortic cross-clamp time, and graft strategy—were evaluated. Postoperative outcomes, such as the incidence of major adverse cardiac and cerebrovascular events, minor complications, and length of stay in ICU and hospital, were also analyzed. Results: Severely obese patients exhibited a longer total operation time (353.5 ± 83.6 min vs. 320.4 ± 73.4 min, p < 0.05). In contrast, no statistical differences were observed in aortic cross-clamp time (97.9 ± 27.6 min vs. 95.6 ± 33.0 min; p = 0.307) or CPB time (163.3 ± 35.0 min vs. 155.0 ± 42.9 min; p = 0.078). Both groups received a similar number of distal anastomoses (3.1 ± 0.7 vs. 3.0 ± 0.8; p = 0.194), and the frequency of total arterial revascularization was comparable (34.9% vs. 40.0%; p = 0.268). There were no differences between the groups in major complications, including hospital mortality (2.3% vs. 1.1%, p = 0.227), stroke (0.0% vs. 0.6% p = 0.300), or need for re-revascularization (0.0% vs. 1.1%, p = 0.248). Similarly, minor complications, such as wound healing issues (2.3% vs. 1.1%, p = 0.233) and revisions for bleeding (4.6% vs. 7.2%, p = 0.276), were comparable between groups. ICU stay (2.7 ± 4.5 days vs. 2.2 ± 4.0 days; p = 0.225) and total hospital stay (12.3 ± 9.6 days vs. 10.8 ± 8.6 days; p = 0.142) showed no meaningful differences. Conclusions: TCRAT can be performed safely and effectively in severely obese patients, providing a feasible minimally invasive option for complete coronary revascularization in cases of multivessel disease. This approach eliminates the complications associated with sternotomy, making it a valuable surgical alternative for this high-risk patient group. Full article

Despite successful primary percutaneous coronary intervention (PPCI), the incidence of heart failure (HF) following ST-elevation myocardial infarction (STEMI) remains high. We investigated using Trimethylamine N-oxide (TMAO), a gut microbiota-derived biomarker, to predict adverse functional left ventricular (LV) remodeling (FLVR) and/or diastolic dysfunction (DD), which are precursors of HF post-STEMI. This prospective, observational study enrolled 204 STEMI patients with multivessel coronary artery disease after PPCI. TMAO level was collected at the baseline and 3 months. An echocardiography was performed at the baseline and at 12 months. The primary endpoints were the number of patients developing Group 4 FLVR or ≥Grade II DD at 12 months. The median age was 65 [57.00, 76.00] and 39.7% were women. The primary endpoints occurred in 47 (23.0%) patients. Three months of TMAO can discriminate patients with/without ≥Grade II LV DD and FLVR Grade 4 with areas under the curve (AUC) of the ROC of 0.72 (95% CI: 0.63–0.81; p < 0.001) and 0.77 (95% CI: 0.63–0.91), respectively. Similar results were shown in the validation cohort of 31 patients. The addition of 3 months of TMAO to traditional risk factors significantly improved the AUCs from 0.675 to 0.736 for ≥Grade II DD and from 0.793 to 0.873 for FLVR Grade 4. In multivariable logistic regression, 3 months of TMAO was independently associated with ≥Grade II DD (OR: 1.29 (1.13–1.50), p < 0.001) and FLVR Grade 4 (OR: 1.28 (1.12–1.47), p < 0.001). Three months of TMAO is strongly associated with LV DD and adverse remodeling after STEMI and may help identifying such patients for early treatment. Full article