As an important public health issue, out-of-hospital cardiac arrest (OHCA) requires several stages of high quality medical care, both on-field and after hospital admission. Post-cardiac arrest shock can lead to severe neurological injury, resulting in poor recovery outcome and increased risk of death. These characteristics make this condition one of the most important issues to deal with in post-OHCA patients hospitalized in intensive care units (ICUs). Also, the majority of initial post-resuscitation survivors have underlying coronary diseases making revascularization procedure another crucial step in early management of these patients. Besides keeping myocardial blood flow at a satisfactory level, other tissues must not be neglected as well, and maintaining mean arterial pressure within optimal range is also preferable. All these procedures can be simplified to a certain level along with using targeted temperature management methods in order to decrease metabolic demands in ICU-hospitalized post-OHCA patients. Additionally, withdrawal of life-sustaining therapy as a controversial ethical topic is under constant re-evaluation due to its possible influence on overall mortality rates in patients initially surviving OHCA. Focusing on all of these important points in process of managing ICU patients is an imperative towards better survival and complete recovery rates.

OBJECTIVE: Several studies have investigated the effectiveness of fractional flow reserve (FFR) guidance in improving clinical outcomes after myocardial revascularization, yielding conflicting results. The aim of this study was to compare clinical outcomes in patients with coronary artery disease following FFR-guided or angiography-guided revascularization.
METHODS: Both randomized controlled trials (RCTs) and nonrandomized intervention studies were included. Coprimary endpoints were all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE). The study is registered with PROSPERO (CRD42022344765).
RESULTS: A total of 30 studies enrolling 393 588 patients were included. FFR-guided revascularization was associated with significantly lower rates of all-cause death (OR, 0.63; 95%CI, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no significant difference between the 2 strategies was observed for any endpoints. However, the use of FFR was associated with reduced rates of revascularizations and treated lesions. Metaregression suggested that the higher the rate of revascularized patients the lower the benefit of FFR guidance on MACE reduction compared with angiography guidance (P=.012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (P=.039).
CONCLUSIONS: FFR-guided revascularization was associated with lower rates of all-cause death, myocardial infarction and MACE compared with angiographic guidance, with RCTs and nonrandomized intervention studies yielding conflicting data. The benefits of FFR-guidance seem to be less evident in studies with high revascularization rates and with a high prevalence of patients with acute coronary syndrome.

Liver transplantation (LT) is the second most performed solid organ transplant. Coronary artery disease (CAD) is a critical consideration for LT candidacy, particularly in patients with known CAD or risk factors, including metabolic dysfunction associated with steatotic liver disease. The presence of severe CAD may exclude patients from LT; therefore, precise preoperative evaluation and interventions are necessary to achieve transplant candidacy. Cardiovascular complications represent the earliest nongraft-related cause of death post-transplantation. Timely intervention to reduce cardiovascular events depends on adequate CAD screening. Coronary disease screening in end-stage liver disease is challenging because standard noninvasive CAD screening tests have low sensitivity due to hyperdynamic state and vasodilatation. As a result, there is overuse of invasive coronary angiography to exclude severe CAD. Coronary artery calcium scoring using a computed tomography scan is a tool for the prediction of cardiovascular events, and can be used to achieve risk stratification in LT candidates. Recent literature shows that qualitative assessment on both noncontrast- and contrast-enhanced chest computed tomography can be used instead of calcium score to assess the presence of coronary calcium. With increasing prevalence, protocols to address CAD in LT candidates must be reconsidered. Percutaneous coronary intervention could allow a shorter duration of dual-antiplatelet therapy in simple lesions, with safer perioperative outcomes. Hybrid coronary revascularization is an option for high-risk LT candidates with multivessel disease nonamenable to percutaneous coronary intervention. The objective of this review is to evaluate existing methods for preoperative cardiovascular risk stratification, and to describe interventions before surgery to optimize patient outcomes and reduce cardiovascular event risk.

Coronary artery bypass grafting (CABG) has witnessed remarkable progress in recent years, driven by innovative techniques and refined approaches that have transformed patient outcomes and treatment paradigms. This review article comprehensively explores the latest advances in CABG techniques and their consequential impacts on patient outcomes. The advent of minimally invasive CABG techniques has revolutionized traditional surgical approaches. Robotic-assisted surgery and small thoracotomy methods offer reduced invasiveness, yielding shorter recovery times and improved patient satisfaction. Integrating CABG with percutaneous coronary intervention (PCI), hybrid procedures have emerged as a versatile strategy, providing tailored treatment solutions for complex coronary anatomies. The paradigm shift to off-pump CABG, which preserves the beating heart during surgery, has shown promise in reducing perioperative complications and neurocognitive deficits. Advances in graft selection, particularly the utilization of arterial grafts such as the internal thoracic artery and radial artery, have significantly enhanced graft patency rates and long-term survival. Adjunctive technologies, such as intraoperative imaging and graft flow assessment, have bolstered the precision of CABG procedures. Pharmacological agents have demonstrated their potential to improve graft outcomes. Surgical decision-making is now optimized based on patient characteristics and disease severity owing to the development of patient selection and risk stratification tools. Long-term results have also significantly improved. Patients undergoing CABG have higher survival rates, less angina, and better quality of life. Developing more resilient grafts through tissue engineering, using bioresorbable materials in graft fabrication, and using gene therapy to improve graft patency and overall cardiac recovery are all exciting future research directions. This review\'s summary of current developments in CABG procedures highlights their profoundly positive effects on patient outcomes. These developments can change the face of cardiovascular care by giving clinicians more tools to treat coronary artery disease (CAD) and enhance patients\' quality of life.

Coronary revascularization interventions have been associated with post-intervention cognitive decline. Hence, this systematic review aims to compare the long-term effects of different coronary revascularization interventions on cognition. The Cochrane Library and MEDLINE databases were searched for articles published between January 2009 and January 2023. Articles on clinical trials and cohort studies that compared at least two different interventions with a minimum three months follow up were included to evaluate the consequences of different intervention techniques on cognition. Each selected study was evaluated using a revised tool to assess the risk of bias in randomized trials (RoB 2), and Risk of Bias In Non-Randomized Studies - of Interventions(ROBINS-1) was used for evaluating non-randomized studies. Five eligible studies, with four different comparisons, were included. Out of these studies, three RCTs and two cohort studies were included A participants gone through different procedures; on-pump and off-pump coronary artery bypass grafting (CABG), Percutaneous coronary intervention (PCI conventional cardiopulmonary bypass (CCPB), the miniaturized cardiopulmonary bypass (MCPB) and endoscopic coronary artery bypass grafting (Endo-CABG). These comparisons showed that different interventions have different effects on cognition; however, there is no solid evidence of correlations between them. Thus, the results of this review suggest that there should be greater focus on comparing interventions and that a reasonable follow-up duration should be set to avoid the influence of confounders. There is also a need to determine the effect of long-term cognitive decline while reducing interference by other variables.

BACKGROUND: Since the foundation of appropriate use criteria (AUC) for coronary revascularization, the proportion of inappropriate (later revised as \"rarely inappropriate\") percutaneous coronary interventions (PCIs) varied in different populations. However, the pooled inappropriate PCI rate remains unknown.
METHODS: We searched the PubMed, Cochrane, Embase, and Sinomed databases for studies related to AUC and PCIs. Studies that reported inappropriate/rarely appropriate PCI rates were included. A random effects model was employed in the meta-analysis because of the high statistical heterogeneity.
RESULTS: Thirty-seven studies were included in our study, of which eight studies reported the appropriateness of acute PCIs or PCIs in acute coronary syndrome (ACS) patients, 25 studies reported the appropriateness of non-acute/elective PCIs or PCIs in non-ACS/stable ischemic heart disease (SIHD) patients, and 15 studies reported both acute and non-acute PCIs or did not distinguish the urgency of PCI. The pooled inappropriate PCI rate was 4.3% (95% CI: 2.6-6.4%) in acute scenarios, 8.9% (95% CI: 6.7-11.0%) in non-acute scenarios, and 6.1% (95% CI: 4.9-7.3%) overall. The inappropriate/rarely appropriate PCI rate was significantly higher in non-acute than acute scenarios. No difference in the inappropriate PCI rate was detected based on the study location, the country\'s level of development, or the presence of chronic total occlusion (CTO).
CONCLUSIONS: The worldwide inappropriate PCI rate is generally identical but comparatively high, especially under non-acute scenarios.

Our study aimed to assess the association between serum cystatin C levels and prognosis in acute myocardial infarction (AMI) patients after coronary reconstructive surgery.
We searched PubMed, Embase, and Cochrane Library up to January 21, 2022 without language restriction. Outcomes were major cardiovascular events (MACEs) and mortality. The risk ratio (RR) and 95% confidence interval (CI) were merged by random-effect models.
We included 8 studies with a total of 7,394 subjects in our meta-analysis. Our meta-analysis showed that higher-level of serum cystatin C levels were associated with higher risk of MACEs (RR = 2.52, 95% CI 1.63-3.89, P < 0.001) and mortality (RR = 2.64, 95% CI 1.66-4.19, P < 0.001) in AMI patients after coronary revascularization. Subgroup analysis showed that the serum cystatin C levels were associated with significantly higher risk of MACEs (RR = 2.72, 95% CI 1.32-5.60, P = 0.006) and mortality (RR = 2.98, 95% CI 1.21-7.37, P = 0.020) in AMI patients after percutaneous coronary intervention (PCI). However, in AMI patients after coronary artery bypass surgery, there were no significantly higher risk of MACEs (RR = 2.41, 95% CI 0.98-5.93, P = 0.05) and mortality (RR = 3.15, 95% CI 0.76-13.03, P = 0.10). Further subgroup analysis showed that this significantly higher risk of MACEs and mortality did not change with the study sample size, study population area or study follow-up time.
The meta-analysis demonstrated that higher serum cystatin C levels were associated with significantly higher risk of MACEs and mortality in AMI patients after PCI. It is a biomarker for risk stratification for predicting the prognosis in AMI patients after PCI.

Background Coronary artery disease (CAD) is highly prevalent in patients with chronic kidney disease and is a common cause of mortality in end-stage renal disease. Thus, patients with end-stage renal disease are routinely screened for CAD before renal transplantation. The usefulness of revascularization before transplantation remains unclear. We hypothesize that there is no difference in all-cause and cardiovascular mortality in waitlisted renal transplant candidates with CAD who underwent revascularization versus those treated with optimal medical therapy before transplantation. Methods and Results This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the modified Newcastle-Ottawa Scale and Cochrane risk of bias tool. The primary outcome of interest was all-cause mortality. Eight studies comprising 945 patients were included (36% women, mean age 56 years). There was no difference in all-cause mortality (risk ratio [RR], 1.16 [95% CI, 0.63-2.12), cardiovascular mortality (RR, 0.75 [95% CI, 0.29-1.89]), or major adverse cardiovascular events (RR, 0.78 [95% CI, 0.30-2.07]) when comparing renal transplant candidates with CAD who underwent revascularization versus those who were on optimal medical therapy before renal transplant. Conclusions This meta-analysis demonstrates that revascularization is not superior to optimal medical therapy in reducing all-cause mortality, cardiovascular mortality, or major adverse cardiovascular events in waitlisted kidney transplant candidates with CAD who eventually underwent kidney transplantation.

Uncertainty exists around the optimal method of leg wound closure following open long saphenous vein harvesting in adults undergoing coronary artery bypass graft surgery (CABG). Such is evident from the variety observed in the closure approach utilised. Consequently, a best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was \'following open long saphenous vein harvesting in adults undergoing CABG, is single-layer leg wound closure superior to multiple-layer closure in terms of post-operative complications encountered? \'. Altogether 382 papers on Ovid Embase and Ovid Medline, 301 papers on PubMed and 11 papers on the Cochrane database were found using the reported search. From the screened articles, 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best method of leg closure following open saphenous vein harvesting for CABG is single-layer cutaneous closure. The use of a suction drain to eliminate the dead space should be considered on a case-to-case basis by the lead operating surgeon with the patient\'s characteristics and their own expertise in mind.

Coronary artery disease (CAD) is highly prevalent in patients with heart failure (HF) and accounts for nearly two-thirds of cases. The use of percutaneous coronary intervention (PCI) in HF patients with CAD has markedly increased and has been suggested to be associated with improved outcomes in numerous observational studies. Randomized data comparing the impact of PCI with that of coronary artery bypass graft (CABG) or contemporary guideline-directed medical therapy alone on clinical outcomes and myocardial recovery in patients with HF are lacking. The purpose of this review is to describe the available evidence regarding the impact of PCI in acute HF (in the presence and absence of an acute coronary syndrome), chronic HF with reduced ejection fraction, and HF with preserved ejection fraction. Adequately-powered randomized clinical trials examining the outcomes with PCI in these distinct HF populations are warranted.