Introduction: To identify the safety and long-term outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents for unprotected left main coronary artery disease (ULMCAD) and to compare outcomes between provisional single-stent and double-stent techniques.
Methods: In this observational study, patients diagnosed with ULMCAD who underwent PCI were enrolled. Clinical data, angiographic characteristics, and outcomes at 1 and 3 years-including cardiac admission, cardiac death, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events (MACCE)-were collected and analyzed at Al-Najaf Cardiac Center.
Results: Between January 2014 and January 2017, 500 patients were included in the study. Mean (SD) age was 65 (11) years, 364 patients (72.8%) were male, and hypertension was the most common risk factor, occurring in 353 patients (70.5%). Distal left main lesions were predominant, occurring in 425 patients (84.9%), and the double-stenting technique was used in 356 cases (71.3%). Procedural success was 100%, with no in-hospital mortality or major complications. At 1-year follow-up, cardiac death was recorded in 4 patients (0.8%), TLR in 8 patients (1.6%), and MACCE in 16 patients (3.1%). At 3-year follow-up, cardiac death increased to 8 patients (1.6%), TLR to 20 patients (4.4%), and MACCE to 41 patients (8.2%). Patients treated with a provisional single stent had significantly lower rates of cardiac hospital admission and MACCE compared with double stenting (1 [0.7%] vs 32 [9%]; P=.0403 and 3 [2.1%] vs 70 [20%]; P=.0054, respectively).
Conclusion: PCI with drug-eluting stents for ULMCAD was safe and effective, with favorable long-term outcomes in patients who were unfit for surgery or refused surgery. The provisional single-stent technique demonstrated better clinical outcomes than the double-stent approach.

Background: Risk stratification for selecting appropriate implantable cardioverter-defibrillator (ICD) therapy remains imperfect, and pragmatic electrocardiogram (ECG)-derived markers may provide incremental information beyond routine clinical variables.
Objective: We sought to evaluate whether a prespecified 6-component ECG burden score improves the prediction of appropriate ICD therapy selection beyond a minimal clinical model.
Methods: Retrospective prediction study using deidentified data from a parent ICD cohort at King Abdulaziz Medical City, Riyadh (n=236; 35 events; mean [SD] follow-up, 7.3 [2.3] years), analyzed under King Abdulaziz Hospital/KAIMRC governance (Protocol No. NRA 26/004/1). Minimal clinical predictors (age, sex, left ventricular ejection fraction, cardiomyopathy type, and ICD indication) were modeled with ridge logistic regression (clinical only) and with the addition of ECG burden (combined). Internal validation used 5-fold cross-validation with out-of-fold predictions.
Results: In complete-case modeling (n=231), out-of-fold discrimination was 0.502 for clinical only and 0.452 for combined (ΔAUC, −0.050; 95% CI, −0.097 to −0.008). In the imputed sensitivity analysis (n=236), discrimination was 0.514 vs 0.485 (ΔAUC, −0.028; 95% CI, −0.066 to 0.008). Decision curve analysis showed minimal separation between the models.
Conclusion: In internal validation, adding the ECG burden score did not improve discrimination beyond minimal clinical predictors and provided only minimal incremental clinical utility in predicting appropriate ICD therapy selection.

Background: Hospitalizations for acute decompensated heart failure (ADHF) impose a substantial health care burden, and prognosis worsens with each readmission. Identifying patients at risk of frequent hospitalization is therefore essential. Red blood cell distribution width (RDW) has recently gained attention as a prognostic biomarker in cardiovascular disease. This study evaluated the prognostic value of baseline RDW and its in-hospital changes in patients admitted with ADHF.
Methods: In this retrospective observational cohort study, all adults hospitalized with ADHF between March 2022 and August 2024 were assessed. Demographic, clinical, echocardiographic, and laboratory data–including admission RDW and in-hospital RDW measurements–were extracted from the hospital information system and medical records. Early readmission for HF within 30 days after discharge was defined as the primary end point, and in-hospital mortality as the secondary end point.
Results: Among 1871 hospitalization records from 1409 patients (66.9% male; mean [SD] age, 59.3 [12.4] years), 984 cases with available follow-up data were analyzed. The mean length of stay (LOS) was 9.5 days, and the mean New York Heart Association (NYHA) class was 3.3. Early readmission occurred in 201 records (20.4% of admissions, 22% of patients). Baseline RDW independently predicted both outcomes: each 1-unit increase in RDW was associated with an 11% higher risk of early readmission and a 16% higher risk of in-hospital mortality. Additionally, a 1-unit increase in the change in RDW from admission to last measurement (ΔRDW) and the ratio of ΔRDW to LOS (ΔRDW/LOS) was linked to a 1.3-fold and 2.3-fold higher mortality risk, respectively.
Conclusion: Baseline RDW on admission is a strong, independent predictor of both early readmission and in-hospital mortality in patients with ADHF. RDW may serve as a simple and cost-effective marker for risk stratification and early intervention in this population.

Background: Primary percutaneous coronary intervention (PCI) remains the main treatment for patients with ST-segment elevation myocardial infarction (STEMI). Nonetheless, many patients still miss the primary PCI golden period or refuse it, especially in developing countries, such as Indonesia. This study compared the effects of delayed PCI (12–48 hours after STEMI onset) and optimal medical therapy (OMT) on cardiac remodeling biomarkers matrix metalloproteinase-9 (MMP-9), nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2), and transforming growth factor-β1 (TGF-β1).
Methods: This quasi-experimental study enrolled 55 patients with STEMI. Initially, all participants were advised to undergo delayed PCI. Patients who agreed to receive delayed PCI plus OMT were included in group 1 (n=24), and those who refused delayed PCI were included in group 2 and received OMT only. Blood samples were drawn at 24 hours and on day 5 after the intervention. MMP-9, NOX2, and TGF-β1 levels were measured using enzyme-linked immunosorbent assay. Data were analyzed using Stata, version 17.
Results: Group 1 showed significant reductions at 24 hours and day 5 in MMP-9 (Cohen d: −0.97, P<0.01 and −0.91, P<0.01, respectively), TGF-β1 (Cohen d: −0.64, P=.01 and −0.73, P<0.01, respectively), and NOX2 (Cohen d: −0.68, P=0.04 and −0.37, P=0.04, respectively) compared with group 2. No significant difference was observed between 24 hours and day 5 within each intervention group.
Conclusion: Delayed PCI performed within 12–48 hours was associated with significantly lower circulating levels of MMP 9, NOX2, and TGF β1 at 24 hours and 5 days compared with OMT alone in STEMI patients with stable conditions.

Background: Hospitalized patients with chronic heart failure (HF) may experience adverse left ventricular remodeling, systemic and pulmonary congestion, and changes in sST2. Thus, they may require an sST2 cutoff for predicting long-term mortality different from that of patients with stable chronic HF. This study aimed to determine the optimal cutoff value of sST2 predictive of long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF).
Methods: This prospective cohort study included 162 hospitalized patients with HFrEF. Plasma sST2 levels were analyzed. Statistical analyses were performed to evaluate the predictive utility of sST2 levels for all-cause mortality and the optimal cutoff value.
Results: During follow-up, 99 of 162 patients (61.1%) died. The median admission sST2 concentration was 35.3 [19.1-57.3] ng/mL. The cohort-derived cutoff was >27.1 ng/mL (sensitivity, 89.9%; specificity, 84.1%). Patients above this threshold had a higher hazard of 5-year mortality than those with sST2 <=27.1 ng/mL (HR, 6.27; 95% CI, 3.02-13.05; P<0.001). In the reported multivariable model, each 1-unit increase in ln(sST2) was also associated with mortality (adjusted HR, 7.52; 95% CI, 4.07-13.90; P<0.001).
Conclusion: In hospitalized patients with HFrEF, sST2 levels were an independent and associated with 5-year all-cause mortality, and the optimal sST2 cutoff for predicting long-term survival is 27.1 ng/mL.

Background: Major depressive disorder (MDD) frequently occurs alongside coronary artery disease (CAD), worsening cardiovascular outcomes. Cilostazol is a phosphodiesterase 3 inhibitor used as an antiplatelet agent with potential antidepressant effects. This study evaluated the efficacy of cilostazol for treating depressive symptoms in participants with CAD.
Methods: This 6-week, double-blind, placebo-controlled clinical trial enrolled individuals with MDD and Hamilton Depression Rating Scale (HDRS) scores of 14 to 17 who had undergone percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Participants were randomly assigned to receive cilostazol (100 mg/d) or placebo. Outcomes included HDRS scores and adverse events.
Results: Baseline characteristics were similar between the groups (all P>.05). A significant time × treatment interaction effect on HDRS scores was observed (P=.037; partial η2=0.055). The cilostazol group showed greater reductions in HDRS scores through weeks 4 and 6 (P=.012 and P=.054, respectively). Adverse effects were not serious and were comparable between the groups (all P>.05).
Conclusion: Cilostazol was beneficial and safe for treating depressive symptoms in individuals who had recently undergone PCI or CABG. Further studies are needed to support broader clinical application.

Background: Delayed coronary artery compression because of a retained epicardial shotgun pellet is an exceptionally rare complication of penetrating cardiac trauma. Its optimal diagnosis and management are not well established.
Case Presentation: We describe a 40-year-old man who presented with new-onset exertional chest pain 4 months after sustaining a shotgun pellet injury to the chest. The initial injury was managed with an emergency thoracotomy for hemopericardium and pulmonary repair, during which several epicardial pellets were left in situ. At our center, examination revealed inferior wall hypokinesia on ultrasonography. Coronary angiography demonstrated high-grade stenosis of the mid-right coronary artery caused by external compression from an adjacent retained pellet. Intravascular ultrasound (IVUS) confirmed extrinsic compression with an intact vessel wall. The patient was successfully treated with percutaneous implantation of a new-generation covered stent, resulting in immediate symptom relief and restoration of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow.
Conclusion: This case highlights a rare mechanism of delayed posttraumatic myocardial ischemia and demonstrates that percutaneous endovascular stenting with a covered stent is a safe and effective minimally invasive alternative to high-risk redo surgery in selected patients. The use of IVUS was crucial in confirming the diagnosis and guiding the therapeutic strategy.

Left ventricular outflow tract obstruction is a presentation of subaortic membrane. Asymmetric septal hypertrophy is an uncommon echocardiographic finding in this condition. Nonetheless, it is a common presentation of hypertrophic cardiomyopathy. These 2 conditions can coexist in the same patient. We describe a woman with a significant obstructive subaortic membrane and asymmetric septal hypertrophy, with a final diagnosis of hypertrophic cardiomyopathy confirmed by cardiac magnetic resonance imaging.

Background: Swallowing-induced atrial tachycardia is a rare condition with variable presentations; syncope is uncommon. Radiofrequency catheter ablation is considered definitive, but management should be individualized, and medical therapy may be appropriate when ablation is not feasible.
Case Presentation: A 78-year-old woman presented with syncope, dizziness, and lightheadedness during meals. Extensive evaluation-including electrocardiography, echocardiography, carotid Doppler ultrasound, chest computed tomography, and laboratory tests-was unremarkable. A 24-hour Holter monitor showed recurrent short runs of atrial tachycardia alternating with sinus rhythm. Episodes consistently occurred during meals and were absent outside eating periods. Continuous monitoring during food intake confirmed swallowing-triggered atrial tachycardia. Although catheter ablation was recommended given the high-risk presentation, the patient declined. Low-dose amiodarone was initiated because of her low baseline heart rate. After 4 weeks, symptoms resolved completely, and repeat Holter showed only a single brief episode. Therapy was switched to bisoprolol (2.5 mg daily) to minimize long-term toxicity. At 12-week follow-up, she remained asymptomatic without adverse effects.
Conclusions: Syncope is a rare manifestation of swallowing-induced tachyarrhythmia. Medical therapy may be an effective alternative, particularly when catheter ablation is unavailable or declined.