Outcomes and Risk Profiles of Acute Coronary Syndrome Patients Treated With Percutaneous Coronary Intervention: Insights From a Brazilian Tertiary Care Center

ABSTRACT Background Acute coronary syndrome (ACS) is a major global health challenge, contributing significantly to cardiovascular mortality. Percutaneous coronary intervention (PCI) is a key treatment strategy, improving survival but requiring further analysis of clinical outcomes. Aims This study aims to evaluate the epidemiological and clinical profiles of ACS patients undergoing PCI, identifying risk factors and major adverse cardiac events (MACE). Methods Data from 79 patients admitted between March and September 2024 were collected using predefined forms. Primary outcomes included clinical progression, MACE, and procedure‐related complications, while secondary variables encompassed demographic and clinical characteristics. Statistical analyses were performed using GraphPad Prism, applying tests for normality, correlation, and significance to assess clinical outcomes and risk factors. Results Among the 79 ACS patients undergoing PCI, 67% were male, with a mean age of 63.01 years ± 12.27 (SD). The most common comorbidities were hypertension, diabetes, and smoking, while ST‐elevation myocardial infarction (STEMI) was the primary indication for PCI (48.1%). Clinical outcomes were generally favorable, with 60.7% of patients experiencing an uneventful course. MACE occurred in 8 patients, with a slightly higher incidence in women (11.53%) than men (9.4%). No significant associations were observed between MACE and demographic or clinical variables (all p  > 0.05). For instance, MACE was not associated with sex ( p  > 0.9999), age ( p  = 0.7119), or arterial disease patterns ( p  = 0.6553). However, diabetes increased the odds of repeat PCI (OR: 5.857, 95% CI: 1.223 to 28.44, p  = 0.0374), and dyslipidemia was linked to a higher likelihood of atypical chest pain (OR: 7.125, 95% CI: 1.496 to 38.81, p  = 0.0333). Conclusion These findings highlight the potential impact of metabolic factors on post‐PCI outcomes.

Impact of Preprocedural Anemia on Outcomes in Patients With Tricuspid Regurgitation Undergoing Transcatheter Edge‐to‐Edge Repair: Insights From the TRISPA Registry

ABSTRACT Background Tricuspid transcatheter edge‐to‐edge repair (T‐TEER) is an established treatment for tricuspid regurgitation (TR) in patients at high surgical risk. Although anemia is a well‐established predictor of poor outcomes in other transcatheter valvular interventions, its role in the tricuspid field remains poorly characterized. Aims To evaluate the clinical impact of anemia in a cohort of patients undergoing T‐TEER. Methods A total of 487 patients undergoing T‐TEER at 15 centers between 2020 and 2025 were included. Anemia was defined as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women. The primary outcome was the composite of all‐cause mortality and heart failure hospitalization (HFH) at 2‐year follow‐up, with each component also evaluated separately as secondary outcomes. Results Anemia was present in 174 patients (35.7%). Compared to those without anemia, patients with baseline anemia had a higher burden of baseline comorbidities, as well as more frequent right ventricular remodeling and tricuspid annular dilatation. Rates of in‐hospital clinical complications were similar between groups ( p  = 0.696), but patients with anemia had higher rates of residual TR ≥ 3+ ( p  = 0.038). The composite endpoint at 2 years (49% vs. 12%, p  < 0.001), as well as all‐cause mortality (26% vs. 9%) and HFH (31% vs. 13%), were significantly higher in anemic patients. In the multivariate analysis, anemia was an independent predictor of all‐cause mortality at follow‐up (hazard ratio 3.03 [1.30–7.96]; p  = 0.01). Conclusions Baseline anemia is common among patients undergoing T‐TEER and is associated with increased mortality and higher TR residual degree.

Clinical Outcomes of Transcatheter Versus Surgical Management of Coronary Artery Disease and Aortic Stenosis

Impact of Sex on Residual Angina After Percutaneous Coronary Interventions

ABSTRACT Background Sex‐related differences in the clinical presentation of coronary artery disease (CAD) are well recognized. The pullback pressure gradient (PPG) characterizes pathophysiological CAD patterns as focal or diffuse. Objectives To evaluate the influence of sex on residual angina at one year after percutaneous coronary intervention (PCI), stratified by PPG. Methods We performed a sub‐analysis of PPG Global, a multicenter, prospective, single‐arm study. All patients had hemodynamically significant CAD (fractional flow reserve [FFR] ≤ 0.80) and underwent a manual FFR pullbacks to calculate PPG before PCI. Patient‐reported outcomes were collected using the 7‐item Seattle Angina Questionnaire (SAQ‐7) at baseline and 1‐year follow‐up. Results We included 814 patients (205 [25.2%] women and 609 [74.8%] men). Women were significantly older than men (70 ± 10 years vs. 67 ± 10 years p  < 0.001). Baseline FFR were comparable between sexes (0.68 ± 0.13 vs. 0.66 ± 0.12, p  = 0.098), but women had a more focal CAD compared to men (PPG 0.66 ± 0.15 vs. 0.63 ± 0.15, p  = 0.047). Post PCI‐FFR was higher in women than men (0.88 ± 0.07 vs. 0.87 ± 0.07, p  = 0.041); however, angina at 1 year was more frequent in women (SAQ angina frequency score 94 ± 12 vs. 96 ± 10, p  = 0.041). Conclusion Despite having a more focal CAD pattern and achieving higher post‐PCI FFR, women report more residual angina than men at 1‐year follow‐up. Trial Registration: ClinicalTrials.gov NCT04789317.

A Bayesian Meta‐Analysis of Renin−Angiotensin System Inhibitors Following TAVR

ABSTRACT Background Aortic stenosis leads to left ventricular remodeling, hypertrophy, and fibrosis, increasing the risk of heart failure. Renin−angiotensin system (RAS) inhibitors may mitigate these adverse effects and improve clinical outcomes. Despite advancements in transcatheter aortic valve replacement (TAVR), substantial mortality, heart failure readmissions, and other complications persist. Aims This study aimed to evaluate the impact of RAS inhibitor therapy following TAVR on clinical outcomes. Methods We conducted a systematic review and Bayesian meta‐analysis following the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search of PubMed, Embase, and Cochrane was performed to identify studies comparing RAS inhibitor (RASi) use versus non‐use in patients undergoing TAVR for aortic stenosis. Odds ratios (OR) and 95% credible intervals (CrI) were estimated using a Bayesian random‐effects model. Between‐study heterogeneity was quantified using the posterior distribution of the heterogeneity parameter (τ). Posterior probabilities (PP) of treatment benefit were calculated, with clinically meaningful effects defined as P (OR < 0.8). All analyses were performed using R version 4.5.0. Results A total of 12 studies comprising 35,988 patients were included, of whom 17,026 (47.3%) received RASi therapy. The mean age ranged from 78.9 to 84.4 years. Post‐TAVR RASi use was associated with a 79.4% probability of a clinically relevant reduction in all‐cause mortality and a 99.5% probability of a clinically relevant reduction in cardiovascular mortality. There was a 54% probability of a clinically relevant reduction in heart failure hospitalization and a negligible (2.26%) probability of a reduction in the odds of myocardial infarction in the RASi group. Conclusions RASi therapy following TAVR is associated with reduced odds of mortality and heart failure readmission.

Clinical Impact of Angiographic Complications Occurring During Percutaneous Coronary Interventions

ABSTRACT Background The clinical impact of different types of angiographic complications during elective PCIs remains largely unexplored. Aims To explore the incidence, management, and outcomes of angiographic complications by type and severity during non‐urgent, non‐CTO PCIs. Methods Clinical and procedural characteristics were prospectively collected and entered in a catheterization laboratory database, including a section dedicated to PCI complications, from 2015 to 2024. Angiographic complications were classified in eight categories: dissections, perforations, device entrapment/fracture, side branch flow impairment, vessel thrombosis, distal embolization, and any temporary or persistent slow‐flow or total occlusion. 30‐days and 1‐year all‐cause mortality were compared between two cohorts with or without angiographic complications, after a propensity score matching for demographic, clinical, procedural and anatomical characteristics. Results Out of 8401 non‐urgent PCIs, 420 (5.0%) presented ≥ 1 angiographic complication (417 patients), with the following incidences: 2.2% iatrogenic dissections, 1.2% side branch flow impairment, 1.2% slow flow, 1.0% vessel occlusion, 0.4% distal embolization, 0.4% vessel thrombosis, 0.4% perforations, 0.1% device entrapment/fracture. Patients with angiographic complications showed a significantly higher risk of 30‐days mortality compared to the propensity score‐matched cohort without angiographic complications (4.1% vs. 1.6%, p  = 0.045). Age, a previous hospitalization for decompensated heart failure, and a procedure on severely calcified lesions were independently associated with 1‐year mortality in patients with angiographic complications. Conclusion Angiographic complications during elective PCI significantly increase 30‐day mortality compared with uncomplicated PCI. A history of decompensated heart failure warrants particular caution in the event of angiographic complications, as it is associated with an increased risk of mortality within the first year after the procedure.

Candida auris in Heart Transplant Donor: First Isolation in a Southern Italy Heart Transplant Center

ABSTRACT Candida auris is an emerging multidrug‐resistant fungal pathogen increasingly implicated in healthcare‐associated outbreaks worldwide. Its presence in organ donors poses a significant threat to transplant recipients due to the risk of invasive infection and limited antifungal treatment options. We report the first isolation of Candida auris in a heart transplant donor at a transplant center in Southern Italy. The donor, a 45‐year‐old woman from Greece, was colonized with C. auris in the bronchoaspirate sample collected at the time of organ retrieval. Despite this colonization, the donor heart was successfully transplanted into a 62‐year‐old male recipient with end‐stage heart failure secondary to myocardial infarction and cardiogenic shock. The recipient received targeted perioperative prophylaxis and was placed under strict isolation protocols. Repeated microbiological surveillance, including blood, urine, and mucosal cultures, revealed no evidence of C. auris transmission. Environmental surveillance of the operating room and ICU also tested negative. The patient recovered uneventfully, showing good cardiac function and no signs of graft rejection or infection. This case emphasizes the critical importance of early detection, thorough microbiological assessment, and stringent infection control in transplantation involving donors colonized with multidrug‐resistant organisms. It also raises the question of whether C. auris should be routinely screened in potential donors and if specific transplant guidelines should be developed to address such emerging threats.

Encapsulated Enigma: Surgical Resolution of a Lingual Lipoma Affecting Oral Functions

ABSTRACT Lingual lipomas are uncommon benign tumors, accounting for < 0.5% of all tongue neoplasms, due to the limited adipose tissue in this region. They are usually asymptomatic and slow growing, which may delay detection. We report the case of a 50‐year‐old man with a 4‐year history of a painless, progressively enlarging submucosal mass on the ventral surface of the tongue. Clinical examination revealed a 3 × 3 cm sessile, yellowish, well‐circumscribed lesion with tense‐elastic consistency. Given its benign appearance, no preoperative imaging was performed. The lesion was surgically excised under local anesthesia, and histopathological analysis confirmed a conventional lipoma composed of mature adipocytes without atypia or lipoblasts. The patient recovered uneventfully and regained full oral function within 2 months. This case emphasizes the importance of including lingual lipomas in the differential diagnosis of tongue masses. It suggests that, in selected cases, clinical assessment alone may be sufficient for diagnosis and treatment planning.

Scalp Melanoma in a Young Patient With Systemic Sarcoidosis: Multidisciplinary Approach

ABSTRACT Often discovered at late stages, scalp melanoma presents unique diagnostic difficulties. Timely detection via public awareness, education, and comprehensive clinical assessment is essential for survival rate improvement. This case report shows the significance of multidisciplinary care and targeted therapies which can achieve remission even in metastatic cases.

A Rare Clinical Manifestation of Disseminated Tuberculosis: Case Report of Tuberculous Meningitis With Flaccid Paralysis

ABSTRACT This case highlights a rare presentation of disseminated tuberculosis in a child, manifesting as tuberculous meningitis and flaccid paralysis due to spinal tuberculosis. Timely initiation of antitubercular therapy, corticosteroids, and ventriculoperitoneal shunt placement led to full recovery, emphasizing tuberculosis consideration in atypical neurological presentations in unvaccinated children with exposure.