INTRODUCTION

The existence of a coronary artery aneurysm (CAA) can pose significant risk for death. It can cause thrombosis, dissection, rupture or myocardial infarction. An exceedingly rare involvement of the left main coronary artery (LMCA), particularly giant-sized is even more catastrophic, a finding seen in only 0.1% of patients. Furthermore, co-existence with significant stenotic coronary artery disease (CAD) portends grim survival. Owing to the rarity of this combination, no data is available locally and only limited case reports are documented internationally. Hence, no consensus guidelines have been published yet. This paper aims to contribute to the sparse medical knowledge on the treatment approach and management of LMCA aneurysm with concomitant CAD.

A 62-year-old male, Filipino, hypertensive and hyperlipidemic sought consult due to one-year exertional chest pain. Coronary angiogram revealed the LMCA to be a diffusely aneurysmal, large-sized vessel measuring 9.7 mm x 7.9 mm with a significant two-vessel CAD affecting the proximal left anterior descending (LAD) and right coronary artery (RCA). As per multidisciplinary decision, the patient underwent surgical revascularization via cardiopulmonary bypass graft (CABG) addressing the CAD and LMCA aneurysm managed conservatively through guideline-directed medical therapy. The patient’s course of treatment was uneventful. He returned for follow-ups for three months post-surgery and remained symptom-free.

Giant coronary artery aneurysms (GCAA) are vessel dilatations that exceed 4x the diameter of a normal adjacent artery. The patient had a unique case of GCAA involving the LMCA combined with two-vessel CAD. Few studies have documented a medical or surgical approach and long-term outcomes are unknown. Without sufficient evidence-based guidelines, the multidisciplinary decision was to perform CABG and manage the LMCA aneurysm conservatively.

Due to extremely limited information available on the giant LMCA aneurysm natural history, definitive management remains controversial. A multidisciplinary team approach is highly recommended for patient-specific needs to achieve favorable outcome and ensure survival.

Introduction: Peripheral arterial disease (PAD) is a common macrovascular complication of type 2 diabetes mellitus (T2DM) and is associated with increased cardiovascular morbidity and mortality. The ankle-brachial index (ABI) is a simple, non-invasive method for detecting PAD; however, Doppler devices are not always available in primary care and resource-limited settings. This study aimed to determine the diagnostic accuracy of ABI measurement using a stethoscope compared with the Doppler method among adults with T2DM. Methods: A diagnostic accuracy study was conducted among 200 adults with T2DM recruited through convenience sampling from a private outpatient clinic in Iloilo City. ABI measurements were obtained using both the stethoscope and Doppler methods. An ABI of ≤0.90 was considered indicative of PAD. Diagnostic accuracy measures, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and agreement, were calculated. Results: The prevalence of PAD was 30.5% using the stethoscope method and 35.0% using the Doppler method. Compared with Doppler ABI, the stethoscope method demonstrated an overall accuracy of 94.5%, sensitivity of 85.7%, specificity of 99.2%, PPV of 98.4%, and NPV of 92.8%. Agreement between the two methods was excellent (Cohen’s κ = 0.88, p < 0.001). Conclusion Stethoscope-based ABI determination demonstrated high diagnostic accuracy and excellent agreement with Doppler ABI. Given its low cost, accessibility, and non-invasive nature, it may serve as a practical screening tool for PAD among adults with T2DM, particularly in primary care and resource-limited settings where Doppler devices are unavailable
Peripheral arterial disease ; Ankle-brachial index ; Stethoscope ; Doppler ultrasound ; Type 2 diabetes mellitus

INTRODUCTION

Coronary artery disease remains a leading cause of mortality worldwide. Although advances in percutaneous coronary intervention (PCI) and stent technology have improved outcomes, in-stent restenosis (ISR) persists as a significant challenge contributing to repeat revascularization, rehospitalization, increased healthcare costs and adverse outcomes.

A single-center retrospective cohort study reviewed medical records from January 2021 to December 2024 to determine the incidence, risk factors and clinical outcomes associated with ISR.

Among 200 patients, ISR occurred in 58 (29%). Factors significantly associated with ISR included hypertension (p = 0.048), smaller stent diameter (OR=0.23, pCONCLUSION

ISR remains a substantial and multifactorial clinical burden highlighting the need for vigilant post-PCI surveillance, aggressive risk factor management and individualized interventional strategies—including optimal stent sizing, lesion preparation and adjunctive imaging use—to reduce restenosis risk and improve long-term outcomes.

INTRODUCTION

Coronary artery disease remains a leading cause of mortality worldwide. Although advances in percutaneous coronary intervention (PCI) and stent technology have improved outcomes, in-stent restenosis (ISR) persists as a significant challenge contributing to repeat revascularization, rehospitalization, increased healthcare costs and adverse outcomes.

A single-center retrospective cohort study reviewed medical records from January 2021 to December 2024 to determine the incidence, risk factors and clinical outcomes associated with ISR.

Among 200 patients, ISR occurred in 58 (29%). Factors significantly associated with ISR included hypertension (p = 0.048), smaller stent diameter (OR=0.23, pCONCLUSION

ISR remains a substantial and multifactorial clinical burden highlighting the need for vigilant post-PCI surveillance, aggressive risk factor management and individualized interventional strategies—including optimal stent sizing, lesion preparation and adjunctive imaging use—to reduce restenosis risk and improve long-term outcomes.

Introduction: Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder characterized by markedly elevated low-density lipoprotein cholesterol (LDL-C) from birth, childhood xanthomas, and accelerated atherosclerotic cardiovascular disease. Achieving LDL-C targets remains difficult despite statins, ezetimibe, and lipoprotein apheresis, especially in patients with treatment interruption, poor adherence, or limited access to specialized lipid services. We report a female with genetically confirmed HoFH who developed severe premature coronary artery disease and showed marked lipid reduction after inclisiran therapy. Case: A 28-year-old Malay female with LDL receptor mutationconfirmed HoFH, diagnosed at age 7, had a strong family history of premature cardiovascular death. She underwent biweekly lipoprotein apheresis from ages 8 to 15 years, but later defaulted on follow-up. During pregnancy in 2021, weekly then biweekly apheresis was reintroduced for severe hypercholesterolemia, but she disengaged postpartum. In 2025, she re-presented with exertional chest pain, orthopnea, and palpitations. Examination showed widespread xanthomas. Electrocardiography demonstrated sinus tachycardia with inferolateral ST depression. Echocardiography revealed a left ventricular ejection fraction of 40%, anterior and septal akinesia, severe mitral regurgitation, moderate tricuspid regurgitation, and pulmonary hypertension. Her lipid profile showed total cholesterol 18.1 mmol/L and LDL-C 14.9 mmol/L. Coronary angiography demonstrated triple-vessel disease with left main stem involvement and critical right coronary ostial stenosis. Coronary artery bypass grafting was advised but declined. She was treated with high-dose rosuvastatin, ezetimibe, dual antiplatelet therapy, and inclisiran 284 mg. After one dose of inclisiran, total cholesterol fell to 6.78 mmol/L and LDL-C to 4.71 mmol/L, a reduction of more than 60%. Conclusion This case highlights the aggressive natural history of inadequately controlled HoFH and the importance of sustained lifelong therapy. Inclisiran may provide additional LDL-C reduction in selected HoFH patients, although long-term cardiovascular outcome data remain limited.
ALN-PCS ; Coronary Artery Disease ; Homozygous Familial Hypercholesterolemia ; Lipids

BACKGROUND

Myocardial bridging (MB) is a congenital coronary anomaly characterized by an epicardial coronary artery taking an intramuscular course, causing systolic compression of the tunneled segment. In comparison to coronary artery disease (CAD), myocardial bridges have been uncommonly associated with acute coronary syndromes and sudden cardiac death.Evidence of accelerated atherosclerotic plaque formation proximal to the bridged segment may increase the risk for future adverse cardiac events in these patients.

This Single–Center Retrospective Study included 323 adult in-patients who underwent coronary angiography for suspected myocardial ischemia in 2022. Clinical information and in-hospital outcomes were obtained by review of medical records.

Myocardial bridging was observed in 31 out of 323 patients (9.60%), with the majority in the mid-left anterior descending artery (87.10%). MB was more prevalent in females (56.62%), and these patients were younger than patients with obstructive CAD (56.9 versus 63.6 years). Chronic Coronary Syndrome was more prevalent in the MB group (82.62%). The coronary segment proximal to the area with MB showed the concurrent presence of obstructive CAD in 16.12% and non-obstructive CAD in 29.03% of cases. In-hospital mortality occurred in 4.44% of the studied population. However, there were no mortalities in the MB group.

Among patients admitted for suspected myocardial ischemia, 9.6% had MB. These patients were younger and, more often, female. Obstructive and non-obstructive CAD were noted in bridged vessels. Although patients with obstructive CAD have a higher risk of experiencing in-hospital death and cardiac complications, evidence of increased atherosclerotic plaque formation in bridged vessels has important implications for future adverse cardiac events and repeat hospitalizations in the MB population. Aggressive risk factor modification, emphasis on long-term follow-up, and the establishment of clinical practice guidelines are therefore necessary for patients with MB.

BACKGROUND OF THE STUDY

Coronary artery disease (CAD) poses a significant global health challenge. In the Philippines, despite increased availability of coronary artery bypass grafting (CABG), cost remains a barrier to access. This research evaluates key factors such as all-cause death, cardiovascular death, repeat revascularization and quality of life post-CABG under the Philippine Health Z Benefit Package (PZBP). Its findings provide critical insights for shaping clinical practices, policymaking and advocating for broader implementation of the PZBP to improve healthcare access and quality of life for post-CABG patients.

This retrospective cross-sectional study explores the outcomes of post-coronary artery bypass grafting (CABG) patients enrolled under the PZBP. The study, conducted at Perpetual Succour Hospital in Cebu City from December 2018 to September 2023, included patients diagnosed with CAD based on ACC/AHA 2021 guidelines. Using a complete enumeration strategy, the research employed descriptive statistics for demographic and clinical profiling, and measured quality of life using the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) tool.

The study analyzed 29 patients who underwent CABG through the PZBP, presenting detailed demographic and clinical data. Most patients (41.4%) fell within the 51-60 age range, with males comprising 75.9%. Diabetes mellitus type II was prevalent (58.6%) and 86.2% had three-vessel diseases. The quality of life assessed with WHOQOL-BREF yielded positive scores across physical, mental, social and environmental domains, indicating favorable outcomes. Notably, no cardiovascular deaths, all-cause deaths, or repeat revascularizations were reported during the study, highlighting the effectiveness of CABG under PZBP.

The study on post-CABG patients under the PZBP shows promising outcomes with no all-cause death, cardiovascular death, or repeat revascularization. This indicates the program's effectiveness in delivering accessible, high-quality healthcare, enhancing long-term survival rates and overall well-being. However, addressing underutilization is crucial, highlighting the importance of raising awareness and utilization to further improve post-CABG patients' outcomes and quality of life.

Intracranial atherosclerosis （ICAS） is the main cause of ischemic stroke in the world. In clinical practice， ICAS is mainly identified through imaging examinations. In recent years， high-resolution magnetic resonance vessel wall imaging （HRMR-VWI） has gradually become an important means for evaluating the characteristics of ICAS plaques. The application of HRMR-VWI has increased the accuracy in identifying the pathogenesis of acute ischemic stroke， providing a reference for the secondary prevention and clinical individualized treatment of stroke. This article systematically reviews the imaging manifestations of the main components of ICAS plaques on HRMR-VWI， summarizes the progress on HRMR technology， and discusses the relationship between intracranial arterial plaque characteristics and stroke occurrence and recurrence as well as the relationship between plaque characteristics and stroke mechanisms， aiming to provide a basis for the diagnosis and treatment of ICAS-related ischemic stroke.
Atherosclerosis

The host-microbe co-metabolism system, generating diverse exogenous and endogenous bioactive molecules that influence the host's immune and metabolic functions, plays a crucial role in the pathogenesis of atherosclerosis. Recent studies have elucidated the interaction between natural medicines and this co-metabolism system. Upon oral administration, natural medicine ingredients can undergo transformation by gut microbiota, potentially enhancing their bioavailability or anti-atherogenic efficacy. Furthermore, natural medicines can exert anti-atherogenic effects via modulation of endogenous host-microbe co-metabolism. This review presents an updated understanding of the dual association between natural medicines and host-microbe co-metabolites. It explores the critical function of microbial exogenous metabolites derived from natural medicines and uncovers the mechanisms underlying natural medicines' intervention on key nodes of endogenous host-microbe co-metabolism. These insights may offer new perspectives for cardiovascular disease (CVD) treatment and guide future drug discovery efforts.
Humans ; Atherosclerosis/metabolism* ; Gastrointestinal Microbiome/drug effects* ; Biological Products/therapeutic use* ; Animals ; Host Microbial Interactions/drug effects*

Coronary artery disease (CAD), one of the most common cardiovascular diseases (CVD), poses a serious threat to physical and mental health, resulting in a severe disease burden. Psychocardiology medicine focuses on the vital role of psychological factors in the development, diagnosis, and treatment of CVD. The prevalence of depression and anxiety is high in patients with CAD. Furthermore, there is a vital interplay among depression, anxiety, mental stress-induced myocardial ischemia, cognitive impairment, and delirium. Both cognitive impairment and delirium adversely impact the prognosis of patients with CAD, warranting increasing attention and the development of interventions. To further direct the clinic diagnosis and treatment of cognitive impairment in patients with CAD complicated with depression and anxiety, and to thus improve the prognosis of such patients, the Psychocardiology Medicine Branch of Chinese Medical Association Beijing Branch, and Psychocardiology Education Professional Committee of China Medical Education Association, together with over 40 other organizations, including more than 50 experts from several related fields, have developed the association standards on guidelines for the cognitive clinical diagnosis and treatment of CAD complicated with depression and anxiety under the framework of the China standard association (No.T/CAS 812-2024).
Humans ; Depression/diagnosis* ; Coronary Artery Disease/psychology* ; Anxiety/diagnosis* ; Practice Guidelines as Topic