Daisuke Kanda

Calcified nodules (CN) are recognized as high-risk morphological features; however, their prognostic impact on stable angina pectoris (SAP) in the contemporary era of intensive lipid-lowering therapy and advanced lesion preparation remains unclear. A total of 322 patients with SAP (450 procedures) who underwent elective intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) were analyzed. CN was identified in 40 patients (12%) at the patient level and in 61 lesions (14%) at the lesion level. The primary endpoint was clinically driven target lesion revascularization (TLR) at the lesion level. All patients received statin therapy following the index PCI. The CN group had higher prevalences of hypertension and hemodialysis and lower estimated glomerular filtration rate than the non-CN group, whereas age, diabetes mellitus, chronic kidney disease, left ventricular ejection fraction, low-density lipoprotein cholesterol (LDL-C), estimated small dense LDL-C (Esd LDL-C), and statin use did not differ significantly between groups. Kaplan–Meier analysis demonstrated a significantly higher cumulative incidence of major adverse cardiocerebrovascular events (MACCE) (p = 0.007) and clinically driven TLR at both patient (p = 0.005) and lesion levels (p < 0.001) in the CN group than in the non-CN group. In multivariable Cox regression adjusting for baseline clinical and procedural variables, CN remained independently associated with TLR (hazard ratio [HR]: 3.63, 95% confidence interval [CI] 1.62–8.14, p = 0.002) and MACCE (HR: 2.59, 95% CI 1.14–5.87, p = 0.023), whereas neither LDL-C nor other lipid parameters independently predicted outcomes. The drug-eluting stent (DES) strategy was independently associated with a lower risk of TLR (HR: 0.25, p = 0.002). In patients with SAP undergoing elective IVUS-guided PCI, all of whom received statin therapy following the index PCI, CN was independently associated with adverse clinical outcomes irrespective of baseline LDL-C or other lipid parameters. These findings suggest that CN represents a distinct high-risk morphological phenotype associated with adverse outcomes after PCI. In the overall cohort, DES use was independently associated with lower TLR than DCB use, although the optimal device strategy for CN lesions warrants further investigation. IVUS-based plaque characterization is essential and may facilitate morphology-oriented risk stratification in contemporary PCI practice.

Background: The European Society of Cardiology (ESC) guidelines for peripheral artery disease recommend antithrombotic strategies based on high ischemic risk (HIR) and high bleeding risk (HBR) criteria. However, their prognostic value in patients with lower extremity artery disease (LEAD) undergoing endovascular therapy (EVT) remains unclear. Therefore, we aimed to evaluate whether the number of ESC‐HIR and ESC‐HBR criteria met was associated with clinical outcomes in Japanese patients treated with EVT. Methods: We retrospectively analyzed 333 patients with LEAD who underwent EVT at a single center. ESC‐HIR and ESC‐HBR scores were separately calculated by assigning 1 point to each criterion and were evaluated independently. The primary outcome was major adverse cardiovascular and limb events (MACLE), defined as the composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Results: Over a median follow‐up of 1175 days, 93 patients had MACLE. Higher ESC‐HIR and ESC‐HBR scores were associated with increased MACLE incidence (log‐rank p = 0.022 and p < 0.001). In the multivariable analysis, ESC‐HBR remained independently associated with MACLE (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.21–2.10; p = 0.001), whereas ESC‐HIR showed a trend toward association (HR, 1.23; 95% CI, 0.99–1.52; p = 0.061). Time‐dependent receiver operating characteristic analysis showed modest discrimination for both scores. Conclusions: ESC‐HIR and ESC‐HBR scores showed limited prognostic performance for MACLE in Japanese patients undergoing EVT for LEAD. Both scores may be useful for risk stratification in Japanese patients; however, these findings require validation in larger studies.

Fulminant myocarditis (FM) is a life-threatening inflammatory cardiac disease that can rapidly progress to cardiogenic shock or fatal arrhythmias. Delayed-onset FM following coronavirus disease 2019 (COVID-19) infection is rare and cases complicated by sustained ventricular fibrillation (VF) are exceptional. A previously healthy man in his late teens developed dyspnoea and complete atrioventricular block after COVID-19 infection. Echocardiography revealed a left ventricular ejection fraction of 30%. Despite veno-arterial extracorporeal membrane oxygenation and Impella CP support, he developed persistent VF lasting for five days, refractory to amiodarone and repeated defibrillation. Continuous intravenous infusion of nifekalant hydrochloride terminated VF and converted to sinus rhythm. Endomyocardial biopsy demonstrated CD68 ⁺ macrophage-predominant inflammation, consistent with COVID-19-associated myocarditis. This case suggests that nifekalant may be a valuable therapeutic option for managing life-threatening ventricular arrhythmias while preserving myocardial contractility in FM following COVID-19 infection.

Background: Cancer survivors have an elevated cardiovascular disease burden, yet the influence of cancer history on coronary calcification and outcomes following percutaneous coronary intervention (PCI) is not well characterized. This study investigated the association between cancer history and coronary calcification assessed by intravascular ultrasound (IVUS), and examined outcomes after IVUS-guided PCI. Methods: We retrospectively evaluated 450 patients with stable angina who underwent IVUS-guided PCI between January 2020 and March 2024 and stratified them into cancer ( n = 110) and non-cancer ( n = 340) groups. Coronary calcification was graded using an IVUS-derived calcium score. Major adverse cardiac and cerebrovascular events (MACCEs) were assessed during follow-up. Multivariate logistic and Cox regression analyses identified predictors of severe calcification (IVUS-calcium score ≥2) and MACCEs excluding cancer-related deaths. Furthermore, outcomes of rotational atherectomy for severely calcified lesions were examined. Results: Patients with a history of cancer had a high prevalence of moderate-to-severe calcification. Cancer history was independently associated with severe calcification (adjusted odds ratio: 2.32; 95% confidence interval: 1.43–3.77; P < 0.001), but not with MACCEs excluding cancer-related deaths. An IVUS-calcium score ≥2 and impaired renal function were independently associated with MACCEs excluding cancer-related deaths. Among patients undergoing rotational atherectomy, clinical outcomes including MACCEs and target lesion revascularization were comparable between groups. Conclusion: Cancer history was associated with a greater coronary calcification burden; however, clinical outcomes following IVUS-guided PCI showed no significant difference between patients with and without cancer. These findings suggest that appropriate IVUS-guided lesion assessment enable safe revascularization in this high-risk population.