There is emerging evidence that plaque features may play a critical role in future acute coronary syndrome. In this study, we analyzed plaque features using an artificial intelligence-enabled algorithm in a clinical cohort who developed non-ST-elevation myocardial infarction (NSTEMI) following coronary CT angiogram (CCTA).

Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of death. Although statins are the foundation of lipid-lowering therapy, many high-risk patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets due to intolerance or insufficient response. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as potent agents that address this residual risk. This review summarizes the clinical efficacy, safety, and mechanistic role of PCSK9 inhibitors in cardiovascular risk reduction. Relevant randomized trials, meta-analyses, and observational studies were analyzed, alongside emerging nonstatin therapies including bempedoic acid, inclisiran, and Angiopietin-like 3 inhibitors. PCSK9 inhibitors, such as alirocumab and evolocumab, have shown LDL-C reductions of up to 62% and significant decreases in major adverse cardiovascular events. Trials like Further cardiovascular outcomes research with PCSK9 inhibition in subjects With elevated risk (FOURIER) and Evaluation of cardiovascular outcomes after an acute coronary syndrome during treatment with alirocumab (ODYSSEY OUTCOMES) reported relative risk reductions of 15-24% in select populations. These agents also reduce lipoprotein(a) (Lp(a)) and stabilize atherosclerotic plaques. Additional therapies like inclisiran and bempedoic acid further expand treatment options, particularly for statin-intolerant patients. PCSK9 inhibitors offer a well-tolerated and effective approach to lowering LDL-C and mitigating cardiovascular risk. Their integration, along with emerging therapies, provides a comprehensive strategy to address residual ASCVD risk and improve patient outcomes. This review highlights the pivotal role of PCSK9 inhibitors in achieving significant LDL-C reduction and improving cardiovascular outcomes, especially in high-risk and statin-intolerant populations. By also targeting Lp(a) and promoting plaque stabilization, these agents address multiple contributors to residual ASCVD risk. Incorporating PCSK9 inhibitors and emerging nonstatin therapies into clinical practice offers a powerful strategy to enhance long-term cardiovascular prevention.

Distal radial access (DRA) is a promising alternative to conventional transradial access for coronary procedures, offering fewer vascular complications, shorter hemostasis, and greater patient comfort. However, the predictors of DRA failure remain insufficiently defined. This study aimed to evaluate the feasibility, safety, and predictors of DRA failure in an all-comer population and to develop an evidence-based strategy to optimize procedural success.

Radial artery occlusion (RAO) is one of the most common complications associated with transradial access in cardiac catheterization procedures. To date there are no standardized protocols, and only a few studies have evaluated the use of anticoagulation for RAO treatment. The current meta-analysis aimed to assess the impact of various anticoagulation strategies on RAO treatment after cardiac catheterization via the transradial route.

Coronary microvascular dysfunction (CMD) is present in approximately 40% of patients with ischemia with no obstructive coronary arteries (INOCA) and has been associated with inflammation. We investigated associations between measures of inflammation of the coronary perivascular adipose tissue assessed by coronary computed tomography angiography (CCTA) and results of invasive coronary function testing (CFT) to diagnose CMD.

Features of high bleeding risk (HBR) determined by the Academic Research Consortium (ARC) are linked to an enhanced risk of bleeding events among patients undergoing percutaneous coronary intervention. This population-based study investigated whether patients with ARC-HBR are at an increased risk of hospitalization for heart failure (HHF) following drug-eluting stent (DES) implantation by analyzing a large-scale national healthcare database.

Spontaneous coronary artery dissection (SCAD) has emerged as an increasingly recognized cause of acute coronary syndromes (ACSs), particularly in young women without traditional atherosclerotic risk factors. While conservative management has become the preferred strategy in most stable patients, the role of antiplatelet therapy in this unique setting remains uncertain. Current clinical practice often extrapolates from ACS guidelines, recommending aspirin monotherapy or dual antiplatelet therapy, despite a paucity of direct evidence. Observational registries have provided conflicting results, with some suggesting a benefit of antiplatelet therapy in reducing recurrent ischemic events, whereas others highlight the potential risks of intramural hematoma propagation and bleeding. This review aims to critically examine the available literature on antiplatelet therapy following conservatively managed SCAD, highlighting mechanistic rationale, guideline perspectives, registry data, and evolving clinical approaches. The discussion emphasizes the need for individualized therapy, the limitations of current evidence, and the urgent requirement for randomized controlled trials to establish optimal antiplatelet strategies in this unique population.

To evaluate the agreement and comparative performance of non-ECG-gated computed tomography (CT) for coronary artery calcification (CAC) quantification compared with ECG-gated CT and to assess measurement variability between Agatston and volume scoring methods.

Plaque disruption and subsequent healing are important contributors to coronary plaque progression; however, the biological mechanisms underlying this process remain incompletely understood. Optical coherence tomography (OCT) enables the identification of previously disrupted plaques, referred to as layered plaques. Proteomic analysis can characterize the molecular signature of layered plaques, providing insights into the biology of plaque disruption and healing. Furthermore, layered plaques indicate a more advanced stage of atherosclerotic disease, and their noninvasive identification could enhance patient risk stratification. This study aimed to identify plasma proteins associated with layered plaques at the culprit lesion in patients with stable angina pectoris (SAP).

The transradial approach (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) offers reduced bleeding, earlier mobilization, and improved comfort compared with the transfemoral approach (TFA). Anatomical and technical challenges may necessitate crossover to TFA, prolonging procedures and increasing complications.

Elevated lipoprotein(a) [Lp(a)] and low high-density lipoprotein-cholesterol (HDL-C) are established cardiovascular (CV) risk factors, but their combined impact on mortality and sex differences remains unclear.

Timely restoration of blood flow is critical for ST-segment elevation myocardial infarction (STEMI) management. We evaluate the effects of time intervals - total ischemic time, time from symptom onset to first medical contact, delay within the healthcare system, and time from hospital arrival to balloon inflation and from arrival at the catheterization laboratory to balloon inflation - on in-hospital mortality among patients with STEMI undergoing primary percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) in severely calcified lesions remains challenging. While orbital atherectomy is a treatment option for calcified lesions, the specific patient and lesion characteristics that predict successful debulking with orbital atherectomy remain unclear. This study aimed to identify the factors associated with a greater minimum lumen area (MLA) after orbital atherectomy.

Historically, the elderly population was underrepresented in clinical trials evaluating the optimal treatment for non-ST-segment elevation myocardial infarction (NSTEMI). Therefore, we aimed to compare invasive versus noninvasive strategies for the management of NSTEMI in older adults.

Older adults undergoing percutaneous coronary intervention (PCI) face unique challenges due to complex anatomy and comorbidities. Intravascular imaging [including intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] has been shown to improve PCI outcomes, but its benefits in older adults are less well established. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare intravascular imaging with angiography alone to guide PCI in older adults.

Thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients with a high thrombus burden remains an important clinical consideration. This study aimed to evaluate the impact of aspiration catheter size on thrombus removal and the slow-flow/no-reflow phenomenon.