Joanna Fluder

Background: Neointimal formation after stent implantation is an important prognostic factor since delayed healing may lead to stent thrombosis. In vivo, optical coherence tomography (OCT) can most precisely assess stent strut coverage. Since analyzing neointimal coverage is time-consuming, artificial intelligence (AI) may offer valuable assistance. This study presents the preliminary results of the AI-based tool’s performance in detecting and categorizing struts as covered and uncovered. Methods: The algorithm was developed using the YOLO11 (You Only Look Once) neural networks. The first step was preprocessing, then data augmentation techniques were implemented, and the model was trained. Twenty OCT pullbacks were used during model training, and two OCT pullbacks were used in the final validation. Results: The presented tool’s performance was validated against two analysts’ consensus. Both analysts showed moderate intraobserver agreement (κ = 0.57 for analyst 1 and κ = 0.533 for analyst 2) and fair agreement with each other (κ = 0.389). The algorithm’s detection of struts was satisfactory (a 92% positive predictive value (PPV) and a 90% true positive rate (TPR)) and was more accurate in recognizing covered struts (an 81% PPV and an 85% TPR) than uncovered struts (a 73% PPV and a 60% TPR). The agreement was κ = 0.444. Conclusions: The initial results demonstrated a good detection of struts with a more challenging uncovered strut classification. Further clinical studies with a larger sample size are needed to improve the proposed tool.

Background: Due to its high resolution, optical coherence tomography (OCT) is the most suitable modality for neointimal coverage assessments. Evaluation of stent healing seems crucial to accurately define their safety profile since delayed healing is connected with stent thrombosis. This study aimed to present an algorithm for automated quantitative analysis of stent strut coverage at the early stages of vessel healing in intravascular OCT. Methods: A set of 592 OCT frames from 24 patients one month following drug-eluting stent implantation was used to assess the algorithm’s effectiveness. Struts not covered on any side or covered but only on one side were categorized as uncovered. The algorithm consists of several key steps: preprocessing, vessel lumen segmentation, automatic strut detection, and measurement of neointimal thickness. Results: The proposed algorithm proved its efficiency in lumen and stent area estimation versus manual reference. It showed a high positive predictive value (PPV) (89.7%) and true positive rate (TPR) (91.4%) in detecting struts. A qualitative assessment for covered and uncovered struts was characterized by high TPR (99.1% and 80%, respectively, for uncovered and covered struts) and PPV (77.3% and 87%). Conclusions: The proposed algorithm demonstrated good agreement with manual measurements. Automating the stent coverage assessment might facilitate imaging analysis, which might be beneficial in experimental and clinical settings.

Dual antiplatelet therapy (DAPT) is mandatory after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation, but optimal DAPT duration remains a topic of intense discussion. The shorter regimen of DAPT might be especially beneficial for high-bleeding-risk (HBR) patients. Novel stent platforms have been designed with innovations that should facilitate vessel healing following stent implantation and enable short DAPT. This review aimed to summarize evidence of the neointimal coverage of short-term stents and their implications for DAPT duration. Results from histological and optical coherence tomography (OCT) studies confirm the significant role of uncovered struts after the implantation of a stent in patients presenting with late stent thrombosis. Several studies have shown favorable vessel healing at one month (with 83.2% of covered struts, on average) and three months following stent implantation (with 93.3% of covered struts, on average). Solely HBR patient trials have proven that one month of DAPT can be applicable and safe in this population. Three-month DAPT was tested in a more diverse population and remains effective and safe in comparison to a longer DAPT regimen. That evidence proves that short-term DAPT might be applicable, especially for HBR patients.

Background: Scientific statements recommend multimodality imaging in myocardial infarction with non-obstructive coronary arteries (MINOCA) to define the underlying cause. Aim: We evaluated the diagnostic yield of intravascular optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) in the MINOCA setting. Methods: In this prospective, single center, observational pilot study, we enrolled patients with MINOCA without previous coronary interventions. All patients underwent three vessel OCT, followed by CMR. Imaging results were combined to determine the mechanism of MINOCA, when possible. Results: We enrolled 10 patients in this pilot study. Women constituted 50% of the analyzed population. The mean age of patients was 52 years. ST-segment elevation was found in 30% of patients. A possible culprit lesion was identified by OCT in 70% of participants, most commonly plaque rupture or erosion. An ischemic pattern of CMR abnormalities was identified in 70% of participants. Myocarditis and Tako-Tsubo were identified in 30%. A cause of MINOCA was identified in all patients using multimodality imaging, while using OCT alone identification occurred in only 70% of patients. Conclusion: In this pilot study, multimodality imaging with OCT and CMR identified potential mechanisms in all patients with a diagnosis of MINOCA, and it has the potential to guide medical therapy for secondary prevention.

Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up. Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression. Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42–0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction. Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed.

Background: Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). Methods: We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medication management options, outcomes, and readmission causes at 36 months follow-up. Results: Patients in the MINOCA group were younger. Females constituted a greater proportion of patients in the MINOCA group when compared to MI-CAD patients. STEMI during admission was diagnosed less frequently in the MINOCA group when compared to the MI-CAD group. All-cause mortality at 12 months was higher in the MINOCA group (10.94% vs. 9.54%, p < 0.001). At 36 months, there was no difference in the all-cause mortality rates (MINOCA 16.18% vs. MI-CAD 14.93%, p = 0.081). All-cause readmission rates were lower in the MINOCA group when compared to the MI-CAD group at both 12 months (45.19% vs. 54.33%, p < 0.001) and 36 months follow-up (56.42% vs. 66.66%, p < 0.001). Conclusions: This is the first description of the clinical features, treatments, and three-year outcomes in a large population of Polish patients. The main finding of this study was a relatively low rate of MINOCA, with high rates of adverse events both at 12 and 36 months follow-up.

Background. Atherosclerosis and bone metabolism share similar molecular and cellular mechanisms. This study aims to evaluate (1) serum concentration of osteogenesis/osteolysis factors panel (Dickkopf-related protein 1 (DKK-1), TNF-α, N-terminal atrial natriuretic peptide (NT-proANP), thrombospondin-2 (TSP-2), osteoprotegerin (OPG), osteocalcin (OCN), osteopontin (OPN), fibroblast growth factor 23 (FGF-23), soluble receptor activator of nuclear factor-kappaB ligand (sRANKL), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), proprotein convertase subtilisin/kexin type 9 (PCSK9)), (2) serum expression levels of micro-RNA- (miR-) 24-1 and miR-6802, and (3) assess their correlation with myocardial injury and LV remodeling and function in the acute phase of STEMI and after 3 months. Methods. Study enrolled 25 STEMI patients (mean age 55.4 ± 8.96 years). Blood samples were collected 4 days and 3 months after myocardial infarction. Serum concentrations of osteogenesis/osteolysis factors were measured using the Luminex assay. Analysis of miR-24-1, and miR-6802 expression was performed with qPCR. LV function and remodeling were assessed by MRI during index hospitalization and 3 months later. Results. There were no significant differences in serum levels of osteogenesis/osteolysis factors and expression of miR-24-1 and miR-6802 between the acute phase and 3-month follow-up. The levels were similar in patients with at least ≥5% improvement of LVEF (n = 10) and those without improvement. There was a negative correlation between the OPG serum level and LVEF during the acute phase of myocardial infarction. Conclusions. In STEMI patients, serum concentrations of osteogenesis/osteolysis factors, as well as miR-24-1 and miR-6802 expression, do not change significantly within the 3-month follow-up and are not correlated with LV remodeling and function.

Introduction To date the early strut coverage with the second-generation durable-polymer ONYX zotarolimus-eluting stent (O-ZES) is unknown. Aim Optical coherence tomography (OCT) assessed the strut coverage of O-ZES at thirty-day follow-up. Material and methods OCT was performed after...