BackgroundThis study was designed to investigate the impact of the serum free triiodothyronine to free thyroxine ratio (FT3/FT4) on both the incidence and long-term prognosis of contrast-induced nephropathy (CIN) following elective percutaneous coronary intervention (PCI).MethodsThis retrospective study was conducted among patients who underwent elective PCI at the Second Hospital of Tianjin Medical University from January 1, 2019, to March 31, 2022. The diagnosis of CIN was established when serum creatinine (SCr) level increased by more than 44.2 mol/L (0.5 mg/dL) or 25% compared to baseline within 48–72 h post-PCI. Logistic regression analysis was employed to identify independent predictors of CIN. Cox regression and survival analysis were utilized to assess factors influencing all-cause and cardiovascular mortality. Furthermore, the correlation between FT3/FT4 and the occurrence of CIN was examined via restricted cubic spline (RCS) analysis.ResultsThe study encompassed a cohort of 1,390 patients, out of whom 173 (12.4%) experienced CINs. Patients diagnosed with CIN exhibited advanced age, a greater prevalence of acute myocardial infarction (AMI) and chronic renal dysfunction, along with a lower level of FT3/FT4 (all P < 0.001). Stratification based on FT3/FT4 quartile resulted in four distinct patient groups. Notably, significant distinctions emerged among the groups in terms of CIN occurrence, all-cause mortality, cardiovascular mortality. RCS analysis depicted a J-shaped relationship between FT3/FT4 levels and the incidence of CIN. The curve showed an inflection point at an FT3/FT4 ratio of approximately 0.306. CIN risk initially decreases and then increases with the increase of FT3/FT4 ratio. Several factors were identified as risk factors for all-cause mortality, including age, myocardial infarction, LVEDD, SCr before PCI, diuretic usage, left main coronary artery disease, and left circumflex artery disease. Conversely, diastolic blood pressure, serum albumin, post ballooning, statin usage, and FT3/FT4 demonstrated protective effects.ConclusionThe FT3/FT4 level was significantly associated with both incidence of CIN and long-term all-cause mortality in patients undergoing elective PCI.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12872-026-05568-4.

BackgroundThe conventional classification of acute coronary syndromes (ACSs) into ST-elevation myocardial infarction (STEMI) and non–ST-elevation myocardial infarction (NSTEMI) relies primarily on electrocardiographic findings, particularly the presence of ST-segment elevation. However, this framework does not consistently reflect the pathophysiological factor most critical to prognosis—acute coronary artery occlusion. A substantial proportion of patients diagnosed with NSTEMI actually present with complete or near-complete coronary occlusion. Adherence to STEMI/NSTEMI-based management algorithms may therefore delay reperfusion in these individuals, potentially increasing morbidity and mortality. We evaluated limitations of the STEMI/NSTEMI model and compared it with the OMI/NOMI paradigm. We hypothesized that an occlusion-centered approach better aligns with prognosis and urgent reperfusion needs.MethodsWe conducted a retrospective single-center chort study of patients with ACS who underwent angiography or percutaneous coronary intervention (PCI). OMI was defined by either the presence of an acute culprit lesion with Thrombolysis in Myocardial Infarction (TIMI) flow grade 0–2, or a culprit lesion with TIMI 3 flow accompanied by high-sensitivity cardiac troponin I level of ≥ 5,000 ng/L.ResultsIn total, 482 patients were included: 375 men (77.8%) and 107 women (22.2%) with a mean age of 58 ± 12 years. Based on angiographic and clinical classification, 222 patients (46.1%) were STEMI − OMI, 61 (12.7%) were STEMI− NOMI, 193 (40%) were STEMI + OMI, and 6 (1.2%) were STEMI+ NOMI. The median door-to- angiography time was 39 min for STEMI + OMI, 73.5 min for STEMI+ NOMI, 540 min for STEMI − OMI, and 600 min for STEMI− NOMI. The median hospital stay was 3 days in both the STEMI + and STEMI − OMI groups, with identical in-hospital mortality rates (4.1%).ConclusionIn this cohort, 46.1% of patients were classified as STEMI − OMI, experiencing markedly longer reperfusion delays than STEMI + OMI patients (median door-to- angiography time: 540 vs. 39 min). These findings suggest that the OMI–NOMI paradigm may offer greater prognostic precision and therapeutic guidance than the traditional STEMI–NSTEMI framework, particularly for patients presenting with chest pain who require emergent angiography/PCI. An occlusion-centered diagnostic approach may expedite reperfusion and improve clinical outcomes in ACS.

Atherosclerosis is marked by irregular intimal plaques, known as atheroma, which intrude into the lumen of medium-sized and large arteries. Small vessel disease (SVD) is a major contributor to stroke and cognitive impairment and frequently coexists with atherosclerosis due to shared vascular risk factors and overlapping pathophysiological mechanisms. This meta-analysis aimed to systematically evaluate the association between atherosclerotic risk factors and the development of SVD in adult and elderly populations. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, ScienceDirect, Elsevier, and Google Scholar were searched for eligible studies published between January 2000 and October 2023. Community-based randomized controlled trials and observational studies assessing atherosclerotic risk factors and SVD-related outcomes, primarily carotid intima-media thickness and carotid plaque, were included. Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using funnel plots and sensitivity analyses. Across 11 studies with sample sizes ranging from 50 to 5,585 participants, age and hypertension consistently demonstrated the strongest associations with SVD. Age showed an odds ratio of 1.07 (95% CI: 1.03–1.11; p = 0.0001), while hypertension yielded a pooled odds ratio of 2.24 (95% CI: 1.90–2.64; p < 0.0001). Diabetes was also significant (OR 1.38; p < 0.0001), whereas metabolic syndrome was not (p = 0.69). The study concludes that hypertension, age, diabetes mellitus, and carotid atherosclerotic markers—particularly carotid plaque—are significant predictors of SVD.

Stress hyperglycemia is a common phenomenon in patients with critical illness, and its association with coronary microcirculation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) remains poorly understood. The coronary angiography-derived index of microcirculatory resistance (AMR) is a tool used to assess coronary microcirculation. This study aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and AMR in STEMI patients undergoing pPCI. Three hundred sixty-two consecutive patients who underwent pPCI at Taizhou People’s Hospital between 2022 and 2023 were initially screened in this observational study. The study populations were classified as three groups according to fasting SHR tertiles: SHR1: SHR ≤ 0.76 (n = 114); SHR2: 0.76 < SHR < 0.96 (n = 110); and SHR3: SHR ≥ 0.96 (n = 113). Restricted cubic spline analysis was performed to explore the relationship between SHR and AMR. Logistic regression analysis was performed to identify independent predictors of high AMR (AMR ≥ 2.5). A total of 337 STEMI patients were included in this observational study. The AMR was significantly lower in SHR1 and SHR2 than that in SHR3 (all P < 0.05). The AMR were positively correlated with SHR (p for overall < 0.001, p for non-linear = 0.236). Multivariable logistic regression analysis identified SHR3 as an independent risk factor for high AMR after adjusting for other covariates (odds ratio: 1.78, 95% confidence interval: 1.040–3.058, p = 0.035). The SHR is an independent predictor of high AMR in STEMI patients undergoing pPCI. These results may offer new insights into the pathophysiology of STEMI and highlight the potential value of SHR as a clinical marker for coronary microcirculation status.

Patent foramen ovale (PFO) is a common congenital cardiac anomaly, and ultra-long tunnel PFO (> 20mm) presents a significant interventional challenge despite routine standard closure. A 68-year-old female with recurrent headaches, chest pain history, and prior right coronary artery stenting was confirmed to have a 37-mm ultra-long tunnel PFO via transesophageal echocardiography (TEE) and digital subtraction angiography (DSA). After initial percutaneous closure failure, the patient was successfully treated with a modified trans-tunnel puncture technique and deployment of an Abbott 18/25mm Amplatzer PFO Occluder. Follow-up showed gradual resolution of residual shunt, with no shunt detected by June 2025. The imaging-guided modified trans-tunnel puncture technique is an effective strategy for complex ultra-long tunnel PFOs.

Amyloidosis is increasingly recognized as a contributor to heart failure, particularly among older adults and patients with heart failure with preserved ejection fraction (HFpEF). Despite advances in diagnostic imaging and disease-modifying therapies, amyloidosis remains underdiagnosed in many settings, and population-level data examining its co-occurrence with cardiovascular disease on death certificates are limited. This study examined two decades of national mortality data to evaluate deaths co-coded with amyloidosis and cardiovascular disease (CVD) in the United States and to assess temporal trends and demographic disparities in age-adjusted mortality rates. A retrospective analysis was conducted using mortality data from the CDC WONDER database spanning 1999-2020. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) using Joinpoint 5.0.2. Between 1999 and 2020, 26,391 amyloidosis and CVD-related deaths occurred among adults aged 25 years and older in the United States. The overall AAMR for deaths co-coded with amyloidosis and CVD increased from 4.40 in 1999 to 9.31 in 2020, with an AAPC of 3.49 (p < 0.001). The most pronounced increase occurred between 2018 and 2020 (APC: 13.60). Rates were higher among men than women, with both sexes showing a marked increase in the last decade. African American or Black individuals had the highest rates (11.40), followed by White (5.11) and Hispanic (3.86) individuals. Rates were highest in the Northeast region (6.71). Metropolitan areas had higher rates than non-metropolitan areas (5.73 vs. 4.76), with a more pronounced increase in metropolitan regions. Age-adjusted mortality rates for deaths co-coded with amyloidosis and cardiovascular disease have increased over time, likely reflecting improved recognition and documentation. Higher rates of co-coded deaths were noted among men, African Americans, and individuals in the Northeast region, highlighting potential disparities in diagnostic access and recognition.

Heart failure (HF) and arterial hypertension (AH) are strongly associated with obesity, with a linear relationship to increasing body mass index (BMI). However, some individuals with obesity do not exhibit signs of HF or AH. This study aimed to compare, for the first time in a large population-based cohort, individuals with obesity who have normal left ventricular function and remodeling (LVFR) and no AH (ObNI) with those who have impaired LVFR or AH (ObI), and corresponding individuals without obesity (NObNI and NObI). A cross-sectional analysis was performed on 4 435 participants from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Participants were grouped into four categories: (1) ObNI (n = 586), (2) ObI (n = 224), (3) NObNI (n = 3 041), and (4) NObI (n = 584). Descriptive analyses compared individuals with obesity with normal LVFR and no AH (ObNI) to the other three groups. Although no significant differences between the two subgroups with obesity could be seen regarding BMI (33.1 vs. 33.5 kg/m2, p = 0.095), there was significant differences in coronary artery calcification score (CACS) levels, where ObNI participants were more prone to show no or very low CACS in comparison with ObI participants (p < 0.001). Also compared to ObI participants, ObNI individuals had lower levels of HbA1c, fasting plasma glucose, triglycerides, and troponin I (all p < 0.001). Furthermore, significant differences were observed between the two groups regarding sedentary behavior (p = 0.041), where ObNI subjects showed a more active lifestyle. Compared with ObNI, individuals with ObI exhibited a higher left ventricular mass index (LVMI; p < 0.001) and lower diastolic function parameters (p < 0.001), while left ventricular ejection fraction (EF) did not differ significantly (p = 0.27). Relative to NObNI, ObNI participants demonstrated increased LVMI (p = 0.007), lower EF (p < 0.001), and impaired diastolic function (p < 0.001). Coronary artery calcification scores (CACS) were higher in ObI than in ObNI (p < 0.001), and ObNI also showed higher CACS than NObNI (p = 0.008). ObNI participants had lower CACS levels, more favorable metabolic profiles, better cardiac function, and greater physical activity than ObI individuals. However, compared to NObNI, they showed higher CACS, increased left ventricular mass, and reduced cardiac function, highlighting distinct cardiovascular risks across obesity phenotypes.

The rising prevalence of atrial fibrillation and flutter (AF/AFL) in individuals aged 55 and older presents a major public health challenge. However, a systematic analysis of the long-term global burden and trends exclusively within this high-risk demographic is lacking. Data from the 2021 Global Burden of Disease (GBD 2021) study were used to analyze AF/AFL burden in this older population. We analyzed trends in prevalence, incidence, deaths, and disability-adjusted life years (DALYs). To assess temporal trends independent of demographic changes, the Estimated Annual Percentage Change (EAPC) was calculated by fitting a log-linear model to the age-standardized rates. Regional and sex-specific differences were compared across five Socio-Demographic Index (SDI) regions. Globally, from 1990 to 2021, the absolute number of individuals with AF/AFL increased from 19.91 million to 47.86 million, and DALYs rose from 3.08 million to 7.80 million. In contrast, the global age-standardized incidence rate remained relatively stable. The burden increased most rapidly in low-to-middle SDI regions, whereas high-SDI regions showed stabilization in rates. While females experienced a higher absolute burden in DALYs and deaths, males exhibited faster increases in age-standardized rates. The largest prevalence increase was observed in individuals aged 95 and older. Our trend-oriented analysis indicates that global burden of AF/AFL in individuals aged 55 and older has markedly increased. This presents a dual challenge for health systems. Targeted, resource-appropriate prevention and management strategies tailored to specific age, sex, and socioeconomic contexts are urgently needed to address this growing global health concern.

Patients play a crucial role in healthcare, and their involvement before surgery has been associated with shorter intensive care unit (ICU) stays and faster recovery following cardiac surgery. To explore the experiences and perspectives of patients and nurses regarding patient involvement in the cardiovascular surgery ICU using a qualitative descriptive approach. This qualitative descriptive study was conducted in the cardiovascular surgery ICU of a regional hospital between September and November 2024. The study included 12 postoperative patients and 12 nurses selected through purposive sampling. Data were collected through in-depth interviews, semi-structured interviews guided by the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. To ensure rigor and trustworthiness, strategies such as investigator triangulation, peer debriefing, reflexivity, and field notes were used during data collection and analysis. Data were analyzed using Creswell’s five-step thematic analysis framework. The analysis of interviews with patients and nurses revealed five main themes: (1) barriers to patient involvement (2), impact on patient health outcomes (3), impact on nurses (4), practices to enhance patient involvement, and (5) recommendations to improve patient involvement. Patients’ previous passive roles in hospital settings and vulnerability in the ICU hindered their active participation. This study revealed that patient involvement in care within the cardiovascular surgery intensive care unit is strengthened by effective communication, trust, collaboration, and nursing support. The findings emphasize the importance of adopting participatory approaches in nursing practice to enhance patient-centered care.