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Stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. This review analyzes the entity of stent thrombosis from a historical and clinical perspective, and chronicles the evolution of this condition through the various generations of stent development, from bare metal to first-generation, second-generation, and third-generation drug-eluting stents. It also delineates the specific risk factors associated with stent thrombosis and comprehensively examines the literature related to each of these risks. Finally, it highlights the preventative strategies that can be garnered from the existing data, and concludes that a multifactorial approach is necessary to combat the occurrence of stent thrombosis, with higher risk groups, such as patients with ST segment elevation myocardial infarction, meriting further research.

Purpose of review Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge. Recent findings Most common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted temperature management are shown to improve survival. Early activation of cardiac catheterization lab for coronary angiography, hemodynamic assessment, and mechanical circulatory support should be considered in patients with shockable rhythm and presumed cardiac cause, those with ST elevation, ongoing ischemia, or evidence of hemodynamic and electrical instability. Randomized controlled trials are lacking in this field and benefits of interventions should be weighed against risk of pursuing a futile treatment. COVID-19 pandemic has added new challenges to the care of OHCA patients. Summary Clinical decision-making to care for OHCA patients is challenging. There is a need for trials to provide evidence-based knowledge on the care of OHCA patients.

Drug addiction has been conceptualized as maladaptive recruitment of integrative circuits coursing through the striatum, facilitating drug-seeking and drug-taking behavior. The aim of this study was to define temporal neuroadaptations in striatal subregions initiated by 3 weeks of intermittent nicotine exposure followed by protracted abstinence. Enhanced rearing activity was assessed in motor activity boxes as a measurement of behavioral change induced by nicotine (0.36 mg/kg), whereas electrophysiological field potential recordings were performed to evaluate treatment effects on neuronal activity. Dopamine receptor mRNA expression was quantified by qPCR, and nicotine-induced dopamine release was measured in striatal subregions using in vivo microdialysis. Golgi staining was performed to assess nicotine-induced changes in spine density of medium spiny neurons. The data presented here show that a brief period of nicotine exposure followed by abstinence leads to temporal changes in synaptic efficacy, dopamine receptor expression, and spine density in a subregion-specific manner. Nicotine may thus initiate a reorganization of striatal circuits that continues to develop despite protracted abstinence. We also show that the response to nicotine is modulated in previously exposed rats even after 6 months of abstinence. The data presented here suggests that, even though not self-administered, nicotine may produce progressive neuronal alterations in brain regions associated with goal-directed and habitual performance, which might contribute to the development of compulsive drug seeking and the increased vulnerability to relapse, which are hallmarks of drug addiction.

Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome characterized by signs and symptoms of heart failure despite normal or near-normal ejection fraction. It is a debilitating chronic disease that affects millions of people worldwide, and due to the paucity of evidence-based pharmacological treatments for HFpEF, nonpharmacological approaches as potential therapeutic alternatives are of growing interest. As a result, renal denervation (RDN), initially developed as a therapeutic tool for resistant hypertension, has become an area of active clinical interest. RDN is a catheter-based procedure that targets the renal sympathetic pathways, aiming to reduce neurohormonal activation and mitigate maladaptive cardiac remodeling. Preclinical studies in animal models have demonstrated that RDN can improve cardiac and vascular fibrosis, reduce renal inflammation, control hypertension, and alleviate endothelial dysfunction. Recent clinical studies have further highlighted the potential benefits of RDN in patients with HFpEF and uncontrolled hypertension. In this review, we aim to outline the pathophysiology of HFpEF and demonstrate the complex clinical interplay involved in how RDN impacts the heart. Moreover, we discuss the present status of clinical studies on RDN and explore its therapeutic potential as a viable treatment for HFpEF.

ObjectiveTo evaluate the association between the timing of invasive mechanical ventilation (MV) initiation and clinical outcomes in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI).DesignRetrospective analysis of a multicentre registry.SettingData were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.Participants1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.Primary and secondary outcome measuresThe primary outcome was in-hospital mortality. Secondary outcomes included comparisons of baseline characteristics, Society of Coronary Angiogram and Intervention (SCAI) shock stage, and clinical parameters among groups based on time to MV.ResultsParticipants were categorised by time from shock diagnosis to MV: early (≤15 min), intermediate (30 min) and late (≥60 min). Median times were 15 min (IQR 10–20), 30 min (IQR 25–35) and 60 min (IQR 45–70), respectively. Baseline characteristics were comparable across groups. Increased delay in MV was associated with a higher mortality risk during the first 60 min post-diagnosis, beyond which the risk plateaued. Delayed MV was an independent predictor of in-hospital mortality (OR 2.14, 95% CI 1.36 to 3.38, p<0.001).ConclusionsEarly initiation of MV in patients with STEMI complicated by CS was associated with lower in-hospital mortality. These findings highlight the importance of timely respiratory support, warranting further investigation in prospective or randomised controlled studies.

ObjectivesTo compare in-hospital and long-term outcomes between culprit-only percutaneous coronary intervention (PCI) and multivessel PCI in patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease.DesignRetrospective subgroup analysis of the multicentre Gulf-Cardiogenic Shock registry.Setting13 tertiary care centres across six Gulf countries (Saudi Arabia, Qatar, Oman, UAE, Kuwait and Bahrain) between January 2020 and December 2022.Participants961 patients with angiographically confirmed multivessel coronary artery disease who underwent PCI were included from the Gulf-Cardiogenic Shock registry. Patients were divided into culprit-only PCI group (n=792, 82.4%) and multivessel PCI group (n=169, 17.6%). Patients with single-vessel disease were excluded.InterventionsPatients underwent either culprit-only PCI (intervention limited to the culprit artery) or multivessel PCI (immediate intervention to both culprit and non-culprit arteries during the same procedure).Primary and secondary outcome measuresThe primary outcome was in-hospital all-cause mortality. Secondary outcomes included reinfarction, cerebrovascular accident, major and minor bleeding events, target lesion revascularisation, target vessel revascularisation, hospital stay duration and freedom from major adverse cardiac and cerebrovascular events (MACCEs) at 6 and 12 months.ResultsHospital mortality was comparable between multivessel PCI and culprit-only PCI groups (43.2% vs 46.1%; p=0.493). Freedom from MACCE rates at 6 and 12 months were 62% and 46% for multivessel PCI versus 70% and 49% for culprit-only PCI, respectively (log-rank p=0.711). Subgroup analysis revealed that culprit-only PCI was associated with increased hospital mortality in patients older than 70 years (OR 1.55, 95% CI: 1.01 to 2.39). Multivariable analysis of the interaction between revascularisation strategy and the subgroups revealed that culprit vessel revascularisation was associated with increased mortality in patients with left main disease (OR: 1.99 (95% CI: 1.22 to 3.27), p=0.006) and left anterior descending lesions (OR: 1.54 (95% CI: 1.06 to 2.25), p=0.025).ConclusionsNo statistically significant differences in hospital mortality or long-term MACCE-free survival were observed between culprit-only PCI and multivessel PCI strategies in patients with cardiogenic shock complicating acute myocardial infarction. However, patients older than 70 years may benefit from a multivessel PCI approach. These findings support current guideline recommendations favouring culprit-only PCI due to reduced procedural complexity while highlighting the need for individualised treatment strategies based on patient age and clinical factors. Further prospective randomised studies are needed to validate these age-specific findings and identify optimal patient selection criteria for each revascularisation strategy.

Coronary subclavian steal syndrome (CSSS) is a rare complication of the internal mammary artery (IMA) grafting in coronary artery bypass surgery. The technical definition is myocardial ischemia due to the reduced flow of blood, or flow reversal in the IMA graft. This in most cases results from hemodynamically significant proximal subclavian artery stenosis. The clinical presentation is variable and ranges from unstable angina to myocardial infarction, and in some cases, sudden cardiac arrest. CSSS is an entity that is hard to diagnose if one is not actively looking for it. The clinical diagnosis is often complicated, and the prevalence of the disorder is frequently underestimated. In this case presentation, we report a case of myocardial infarction that resulted from significant proximal subclavian artery stenosis.

A high-strength Al-Zn-Mg-Cu alloy AA7075-T6 was friction-stir welded with various process parameter combinations incorporating the design of the experiment to investigate the effect of welding parameters on the microstructure and mechanical properties. A three-factors, five-level central composition design (CCD) has been used to minimize the number of experimental conditions. The friction-stir welding parameters have significant influence on the heat input and temperature profile, which in turn regulates the microstructural and mechanical properties of the joints. The weld thermal cycles and transverse distribution of microhardness of the weld joints were measured, and the tensile properties were tested. The fracture surfaces of tensile specimens were observed by a scanning electron microscope (SEM), and the formation of friction-stir processing zone has been analyzed macroscopically. Also, an equation was derived to predict the final microhardness and tensile properties of the joints, and statistical tools are used to develop the relationships. The results show that the peak temperature during welding of all the joints was up to 713 K (440 °C), which indicates the key role of the tool shoulder diameter in deciding the maximum temperature. From this investigation, it was found that the joint fabricated at a rotational speed of 1050 rpm, welding speed of 100 mm/min, and shoulder diameter of 14 mm exhibited higher mechanical properties compared to the other fabricated joints.