Homocysteine is an independent predictor of long-term cardiac mortality in patients with stable coronary artery disease in the era of statins Background Homocysteine (Hcy) is considered a risk factor for cardiovascular disease. Objective To explore the long-term prognostic value of Hcy in patients with stable coronary artery disease (CAD) in the era of statins. Methods A total of 876 consecutive patients with stable CAD were recruited and followed up for a median of 6.1 years. Lipids and Hcy levels were measured at baseline. Primary endpoints were cardiac death and secondary endpoints were hospitalizations for acute coronary syndrome, myocardial revascularization, arrhythmic event or ischemic stroke. Results Follow-up data were obtained from 842 patients of whom 70 had a cardiac death (8.3%), while 258 (30.6%) met the secondary endpoints. Seven hundred four patients (83.6%) were on statins. In univariate Cox regression analysis Hcy predicted the occurrence of cardiac death [hazard ratio: 1.030; 95% confidence interval (CI): 1.018–1.042, P < 0.001] but not the occurrence of secondary endpoints (hazard ratio: 1.010; 95% CI: 0.999–1.020, P = 0.081). Hcy remained an independent predictor of cardiac death after adjustment for conventional risk factors, ejection fraction and statin use (hazard ratio: 1.030; 95% CI: 1.017–1.044, P < 0.001). Patients in the highest tertile of Hcy levels (>14.1 μmol/L) had three times higher risk of cardiac death compared with patients in the lowest tertile (<10.3 μmol/L) (hazard ratio = 3.036, CI: 1.983–4.649, P < 0.001). Conclusion Hcy is an independent predictor of cardiac death in patients with stable CAD in the era of statins. Received 28 March 2019 Accepted 25 August 2019 Correspondence to Loukianos S. Rallidis, MD, FESC, Second Department of Cardiology, University General Hospital “Attikon”, 1 Rimini, 12462 Chaidari, Athens, Greece, Tel: +30 210 992 9106; fax: +30 210 5832351; e-mail: lrallidis@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Impact of periprocedural biomarker elevation on mortality in stable angina pectoris patients undergoing elective coronary intervention: a systematic review and meta-analysis including 24 666 patients Background Uncertainty remains regarding the exact prognostic impact of biomarker elevation following percutaneous coronary intervention in patients with stable angina pectoris and the subsequent risk of death. We sought, therefore, to evaluate the effect of periprocedural myocardial infarction on the subsequent mortality risk following percutaneous coronary intervention in patients with stable angina pectoris and normal preprocedural cardiac biomarkers level. Methods After a systematic literature search was done in PubMed and EMBASE, we performed a meta-analysis of studies with post-procedural cardiac biomarkers data. All-cause mortality and cardiac death were evaluated in subjects with stable angina pectoris who underwent an elective coronary intervention. Results Fourteen studies with 24 666 patients were included. The mean age was 64.2 years ± 9.8 with about 3-quarters (74.9%) of these patients being men. The mean duration of follow-up was 18.1 months ± 14.3. Periprocedural myocardial infarction, based on study-specific biomarker criteria, occurred in 14.3% of the patients. Periprocedural myocardial infarction conferred a statistically significant increase in the risk of all-cause mortality (odds ratio, 1.62; 95% confidence interval, 1.30–2.01; P < 0.0001; I2 = 0%); where reported separately, cardiac death was also significantly increase (odds ratio, 2.77; 95% confidence interval, 1.60–4.80; P = 0.0003; I2 = 0%). Conclusion The occurrence of periprocedural myocardial infarction after an elective percutaneous coronary intervention in patients with stable angina pectoris is associated with a statistically significant increase in subsequent all-cause mortality and cardiac mortality. Received 27 June 2019 Accepted 25 August 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Hector M. Garcia-Garcia, MD, PhD, Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA, Tel: (202) 877 7754; fax (202) 877 2715; e-mail: Hector.M.GarciaGarcia@medstar.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Comparison of efficacy and safety between ultrathin bioresorbable polymer sirolimus-eluting stents and thin durable polymer drug-eluting stents: a systematic review and meta-analysis of the literature Objective Ultrathin bioresorbable polymer sirolimus-eluting stents (BP SES) have been proposed as an alternative to thin durable polymer drug-eluting stents (DP DES). Although BP SES show a significant decrease in target lesion failure rates, clear superiority with respect to efficacy and safety of BP SES in comparison to DP EES has not been consistently proven. Methods and Results A comprehensive search of several electronic databases identified studies that assessed efficacy and safety of BP SES, compared with DP EES. Relative risks (RRs) were pooled across studies using a fixed-effects model and a random-effect model, respectively, calculating pooled RRs and associated 95% confidence intervals (CIs). The I2 statistic was used to assess heterogeneity. We retrieved six studies enrolling >7000 patients. BP SES significantly reduced the risk of target vessel myocardial infarction (RR, 0.79; 95% CI, 0.64–0.97; I2 = 0%; Test for overall effect: z = 2.24, P = 0.03) in comparison with DP EES using a random-effects model. Use of BP SES was associated with a significant reduction in any myocardial infarction (RR, 0.83; 95% CI, 0.70–0.98; I2 = 12%; Test for overall effect: z = 2.19, P = 0.03), using a fixed-effects model. The subgroup analyses demonstrated, following-up ≥2 years, a statistically significant 27% RR increase in the risk of all-case death for patients randomized to BP SES (RR, 1.27; 95% CI, 1.01–1.60; I2 = 0%; Test for overall effect: z = 2.08, P = 0.04). No differences in cardiac death, stent thrombosis events (STE), target lesion revascularization (TLR) and target vessel revascularization (TVR) between BP SES and DP EES were observed. Conclusion BP SES significantly reduced the risk of any myocardial infarction and target vessel myocardial infarction in comparison with DP EES. There were no differences in cardiac death, STE, TLR, TVR and all-cause death with its follow-up time <2 year between BP SES and DP EES. Following-up ≥2 years, a statistically significant 27% RR increase in the risk of all-case death for patients randomized to BP SES was observed. Received 8 May 2019 Accepted 25 August 2019 MCA/CAD – Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Ju-xiang Li, The Second Affiliated Hospital of Nanchang University, Bayi Avenue, Donghu district, Nanchang, China, Tel: +86 18970940267; fax: +0791 86297276; e-mail: 13337107502@163.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Reasons for early discontinuing or switching of antiplatelet therapy in elderly patients after acute coronary syndrome Objective This study aims to determine frequency and reasons for prematurely discontinuing or switching antiplatelet therapy in elderly patients admitted with non-ST-elevation acute coronary syndrome (NSTE-ACS). Method Patients of 75 years or older admitted with suspected NSTE-ACS were included between 2013 and 2016. Information was extracted from the patients’ medical files. Results A total of 544 patients were included, 17.3% discontinued aspirin within one year, predominantly (57%) within 30 days. The most common reason was the start of a (non-vitamin-K) oral anticoagulant [(N)OAC], either combined with a P2Y12-inhibitor (43%) or as monotherapy (16%). The P2Y12-inhibitor was discontinued in 31.2% of patients within one year, of which 46% within 30 days. The most common reason was undergoing coronary artery bypass grafting (CABG; 22%). Switching of clopidogrel seldom occurred; however, ticagrelor was switched in 50/179 patients mainly due to dyspnoea (42%). Independent predictors for prematurely discontinuing antiplatelet therapy were undergoing CABG [odds ratio (OR) 3.257 (95% confidence interval [CI] 1.836–5.779)], need for (N)OAC [OR 2.167 (95% CI 1.423–3.300)] and type II ACS as final diagnosis [OR 3.793 (95% CI 1.721–8.361)]. Undergoing percutaneous coronary intervention [OR 0.393 (95% CI 0.243–0.634)] and use of clopidogrel [OR 0.441(95% CI 0.293–0.662)] were independent predictors of continuing antiplatelet therapy. Conclusion In elderly patients of at least 75 years with NSTE-ACS, antiplatelet therapy is frequently discontinued prematurely, most often within 30 days. Main reasons for discontinuing are need for (N)OAC, undergoing CABG or type II ACS as final diagnosis and suffering from dyspnoea while on ticagrelor. Received 6 March 2019 Accepted 20 July 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Marieke E. Gimbel, MD, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands, Tel: +31 88 3201218; fax: +31 84 0033422; e-mail: m.gimbel@antoniusziekenhuis.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Clinical and angiographic factors predicting fractional flow reserve and explaining the visual–functional mismatch in patients with intermediate coronary artery stenosis Background Visual–functional mismatch between coronary angiography and fractional flow reserve (FFR) has been reported, and the underlying reason remains poorly understood. Therefore, the relationship between angiographic measurements and FFR was evaluated, and predictors for FFR in intermediate coronary artery stenosis were determined. Methods Consecutive 314 patients (405 lesions) with a lesion of 30–80% angiographic diameter stenosis who underwent invasive FFR were recruited. The myocardial area supplied by the coronary artery distal to the stenosis was evaluated using a modified version of the Bypass Angioplasty Revascularization Investigation (BARI) score. Participants underwent follow-up, and major cardiovascular events (MACE), including all-cause death, myocardial infarction (MI), and unplanned revascularization were recorded. Results Although % diameter stenosis was correlated with FFR (R = 0.279, P < 0.001), diameter stenosis-FFR mismatch was observed in 37.8% of the lesions. Although FFR values were not associated with clinical factors, such as age, sex, and comorbidities, it was correlated with minimal lumen diameter (MLD), diffuse lesion, presence of proximal lesion, and BARI score. In addition, the lesions in left anterior descending (LAD) coronary artery showed low FFR values compared with those in the left circumflex coronary artery or right coronary artery. In multivariate logistic analysis, MLD (β coefficient = 0.330), diffuse lesion (β coefficient = –0.266), proximal lesion (β coefficient = –0.144), BARI score (β coefficient = –0.219), and LAD lesion (β coefficient = –0.293) were all independent predictors for FFR value. The estimated FFR value based on these factors showed smaller mismatch and higher sensitivity. No difference was observed in the event rates for MACE and MI or revascularization between the FFR-guided and estimated FFR-guided strategies. Conclusions MLD, diffuse lesion, proximal lesion, BARI score, and lesion vessel were independent predictors for FFR in intermediate coronary stenosis. Not only the extent of local lesion stenosis but also the amount of myocardial supply and the lesion location may determine the physiological significance and explain the visual–functional mismatch. The estimation of FFR by these factors may be useful in clinical practice. Received 2 March 2019 Accepted 7 September 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Yoshitaka Iwanaga, MD, Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama 589-8511, Japan, Tel: +81 72 366 0221; fax: +81 72 368 2378; e-mail: yiwanaga@med.kindai.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Burden of exposure to medical radiation following an acute coronary syndrome No abstract available

Estimates of radiation exposure and subsequent risk of malignancy due to cardiac imaging in the emergency department for evaluation of chest pain: a cohort study No abstract available

Temporal pattern of neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention No abstract available

Dissociation of coronary computed tomography and stress myocardial scintigraphy: a case of vasospasm Exercise-induced vasospastic angina (VSA) is an uncommon entity of coronary artery disease. Here, we report a case of exercise-induced VSA, which was detected by exercise stress myocardial perfusion imaging. Received 11 March 2019 Accepted 25 August 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Correspondence to Itsuro Morishima, MD, PhD, Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan, Tel: +81584813341; fax: +81584755715; e-mail: morishima-i@muc.biglobe.ne.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Prognostic impact of lipoprotein(a) levels during lipid management with statins after ST-elevation acute myocardial infarction The causal relationship of lipoprotein(a) with cardiovascular disease has been established. However, clinical impacts of lipoprotein(a) levels on adverse vascular events in patients with established coronary artery disease who are undergoing statin treatment have not been fully elucidated. We measured lipoprotein(a) levels of 668 consecutive patients with ST-elevated myocardial infarction upon admission and reevaluated lipoprotein(a) of 189 of these patients during statin treatment at least 6 months later than the date of index ST-elevated myocardial infarction. Changes in lipoprotein(a) and associations between lipoprotein(a) levels and the incidence of major adverse cardiac and cerebrovascular event for 3 years were examined. Lipoprotein(a) at baseline was an independent predictor of 3-year major adverse cardiac and cerebrovascular event after ST-elevated myocardial infarction. Levels of lipoprotein(a) at follow-up were slightly but significantly elevated despite improvements in other lipid parameters due to statin treatment. Furthermore, higher levels of lipoprotein(a) achieved with statin treatment were also associated with the subsequent incidence of major adverse cardiac and cerebrovascular event over 3 years, regardless of whether or not the LDL-cholesterol levels were below 100 mg/dl. In conclusion, lipoprotein(a) levels during lipid management by statin are also predictive of adverse vascular events in Japanese patients with ST-elevated myocardial infarction. Received 30 April 2019 Accepted 25 August 2019 Correspondence to Yusuke Uemura, MD, PhD, Department of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo 446-8602, Japan, Tel: +81 566 75 2111; fax: +81 566 76 4335; e-mail: yusuke0307@kosei.anjo.aichi.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.