This VEDLOR-STEMI study assessed the safety and efficacy of very-early discharge (VED- ≤ 48 h) after primary percutaneous coronary intervention (PPCI) for patients with ST elevation myocardial infarction who are consider...This VEDLOR-STEMI study assessed the safety and efficacy of very-early discharge (VED- ≤ 48 h) after primary percutaneous coronary intervention (PPCI) for patients with ST elevation myocardial infarction who are considered low risk and compared their outcome with low-risk patients who had standard discharge protocol. No major adverse cardiac events (MACCE) occurred within 6 months. Minor complications, like access site pain were managed without readmission. High patient satisfaction (97.3 %) was noted, with 48 % actively utilizing a hotline for queries. VED post-PPCI appears feasible and safe with appropriate discharge protocols and follow-up.
BACKGROUND: Ventricular arrhythmia is an important cause of death in myocardial infarction (MI). Fragmented QRS (fQRS) is an ECG pattern reflecting the inhomogeneity of ventricular conduction and has been demonstrated to...BACKGROUND: Ventricular arrhythmia is an important cause of death in myocardial infarction (MI). Fragmented QRS (fQRS) is an ECG pattern reflecting the inhomogeneity of ventricular conduction and has been demonstrated to be a predictor of arrhythmia in several cardiac conditions. This study aimed to evaluate the prognostic impact of fQRS on arrhythmias in MI patients. METHODS: A systematic search was conducted using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to July 20, 2024. The inclusion criteria were studies that included MI patients and compared the rate of in-hospital arrhythmia between fQRS and non-fQRS participants. RESULTS: A total of 14 studies were included in this meta-analysis, involving 4566 participants. The presence of fQRS was associated with a higher incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) compared to non-fQRS, with an odds ratio (OR) of 2.96 (95 %CI 2.00 to 4.39), p < 0.01. Similarly, fQRS was associated with a higher risk of VT, with an OR of 3.59 (95 %CI 1.66 to 7.80), p < 0.01. Although the presence of fQRS did not significantly increase the risk of VF compared to non-fQRS, a sensitivity analysis that excluded a study with serious risk of bias showed that the presence of fQRS was associated with an increased risk of VF, with an OR of 2.45 (95 %CI 1.38 to 4.35), p < 0.01. CONCLUSIONS: The presence of fQRS was associated with a higher risk of in-hospital arrhythmia in MI patients. The fQRS is a potential tool for risk stratification in MI patients for arrhythmia.
A hemodynamically significant patent ductus arteriosus (PDA) may be associated with mitral regurgitation (MR). Available treatment strategies are - surgical PDA ligation ± mitral valve surgery and initial transcatheter P...A hemodynamically significant patent ductus arteriosus (PDA) may be associated with mitral regurgitation (MR). Available treatment strategies are - surgical PDA ligation ± mitral valve surgery and initial transcatheter PDA closure (PDA-DC) with treatment of MR subsequently, if necessary. We aimed to describe the fate of MR after PDA-DC in patients with PDA and significant MR. On retrospective review of electronic health records between 2013 and 2023, 14 eligible patients were identified. Amongst them, PDA-DC resulted in symptomatic improvement in all. A reduction in the severity of MR was noted in 12 patients (85.7 %).
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) can show recovery in some patients, especially with non-ischemic causes, leading to better outcomes. Recovery varies due to factors like aetiology and seve...BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) can show recovery in some patients, especially with non-ischemic causes, leading to better outcomes. Recovery varies due to factors like aetiology and severity of myocardial injury. This study examines the incidence and predictors of left ventricular ejection fraction (LVEF) recovery in non-ischemic HFrEF patients. METHODS: This was a prospective observational study conducted at a tertiary care hospital, involving 500 patients with non-ischemic HFrEF (baseline LVEF <40 %). Patients were followed for a duration of 8 years (2011-2023) with periodic clinical assessments and annual echocardiographic evaluations. Data on comorbidities, baseline cardiac function, medication adherence, and clinical events were collected. The incidence rate of LVEF recovery was determined, and Kaplan-Meier survival analysis was used to identify recovery trends over time. Predictors of recovery were evaluated using Cox proportional hazards models. RESULTS: Cumulative incidence of LVEF recovery was 27.4 % (95 % CI: 23.7-31.5) at 8 years, with an incidence rate of 4.5 per 100 person-years. Higher baseline LVEF (≥30 %) strongly predicted recovery (HR: 2.17, p < 0.001), while dilated LV (LVEDD ≥60 mm, HR: 0.6, p = 0.02) and diabetes (HR: 0.36, p = 0.01) were associated with lower recovery. Education (≥Class 5) was linked to better recovery (HR: 1.45, p = 0.04). Beta-blockers showed a potential but nonsignificant benefit. CONCLUSION: Nearly one-fourth (27.4 %) of patients achieved LVEF recovery over 8 years, with higher baseline LVEF and education associated with better outcomes, while adverse cardiac remodeling and diabetes were linked to lower recovery.
OBJECTIVE: Rotational atherectomy (RA), a commonly used technique for the percutaneous intervention of calcific coronary lesions, produces micro-debris which cause downstream microvascular obstruction, slow flow, and myo...OBJECTIVE: Rotational atherectomy (RA), a commonly used technique for the percutaneous intervention of calcific coronary lesions, produces micro-debris which cause downstream microvascular obstruction, slow flow, and myocardial stunning leading to adverse outcomes in patients with left ventricular (LV) systolic dysfunction. Hence, the presence of LV dysfunction was considered a relative contraindication for RA. We aimed to assess the safety of RA in patients with LV dysfunction. METHOD: This is a retrospective review of all consecutive patients who underwent RA at our tertiary referral centre over a 6-year period (2018-2023). All medical records, procedural details, and in-hospital outcomes were recorded. The primary outcome of the study was in-hospital mortality. RESULTS: 504 patients who underwent RA during the study duration were divided into two groups: Group 1 (n = 209) with left ventricular ejection fraction (LVEF) ≤35 % (mean 29.14 ± 4.95 %) and group 2 (n = 295) with moderately reduced or preserved LVEF >35 % (mean 47.86 ± 6.68 %). There was no significant difference in the baseline demographic characteristics, risk factors, angiographic profile, stent length, contrast volume, and procedure time between the two groups. The in-hospital mortality was not different between the two groups (2.3 % vs 0.7 % p = 0.63). LVEF was not found to be an independent predictor of mortality in patients undergoing RA. CONCLUSION: The in-hospital mortality of patients undergoing PCI with RA was not affected by the presence of LV dysfunction. Additional studies with a longer follow-up duration and a larger sample or a meta-analysis incorporating our study are needed to confirm these results.
The Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unkno...The Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unknown cause. The ability of a positive HUTT often to reproduce patient symptoms and illustrate to the patient that the physician is confident of the diagnosis have been major advances in clinical TLOC management. Tilt testing has been particularly important in understanding and diagnosing vasovagal syncope (VVS) and orthostatic hypotension. Despite HUTT having great clinical utility, different HUTT protocols and drug provocations result in different test yields. Limited HUTT reproducibility has led some researchers to criticize HUTT utility. As in most medical tests, limitations are part of the test. Herein, we provide a contemporary review of HUTT's utility in diagnosing and managing various TLOC disorders with intent to clarify its role in clinical practice.
OBJECTIVE: Drug eluting stent (DES) could result in both in-stent restenosis and high bleeding risk due to long-term anti-platelet therapy. Drug-coated balloon (DCB) delivers anti-proliferative drugs without implanting m...OBJECTIVE: Drug eluting stent (DES) could result in both in-stent restenosis and high bleeding risk due to long-term anti-platelet therapy. Drug-coated balloon (DCB) delivers anti-proliferative drugs without implanting metal into vascular wall. Our aim was to investigate its feasibility in large vessel coronary artery disease (LvCAD), compared to small vessel coronary artery disease (SvCAD). METHODS: This study enrolled 237 patients with de novo coronary lesions treated with DCB-only strategy and categorized according to the reference vessel diameter of 3 mm into SvCAD and LvCAD groups. The primary endpoint was in-lesion late lumen loss (LLL). The secondary endpoints included composite major adverse cardiac events (MACE), cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and vessel thrombosis. RESULTS: The immediate (3.06 ± 0.25 vs. 2.33 ± 0.21 mm, p = 0.001) and follow up minimal lumen diameter (3.13 ± 0.25 vs. 2.41 ± 0.21 mm, p = 0.001) and acute gain (1.92 ± 0.29 vs. 1.5 ± 0.26 mm, p = 0.04) were significantly higher in LvCAD group. In-lesion LLL was negative without significant difference (-0.07 ± 0.02 vs. - 0.06 ± 0.04 mm, p = 0.69). The incidence of adverse clinical events was not statistically significant accounting for 6.5 % vs. 10.5 % for composite MACE (p = 0.27), 0.8 % vs. 0.9 % for cardiac death (p = 0.96), 4.9 % vs.7 % for non-fatal MI (p = 0.49), 4.1 % vs. 6.1 % for TLR (p = 0.47), 2.4 % vs. 3.5 % for TVR (p = 0.63) and 1.6 % vs. 2.6 % for vessel thrombosis (p = 0.59). CONCLUSION: DCB-only strategy is effective in treating LvCAD with comparable outcomes to SvCAD.
INTRODUCTION: The capability to accurately predict the ejection fraction (EF) from an electrocardiogram (ECG) holds significant and valuable clinical implications. Various algorithms based on ECG images are currently bei...INTRODUCTION: The capability to accurately predict the ejection fraction (EF) from an electrocardiogram (ECG) holds significant and valuable clinical implications. Various algorithms based on ECG images are currently being evaluated, with most methods requiring raw signal data from ECG devices. In this study, our objective was to train and validate a neural network on a readily available ECG trace image graph to determine the presence or absence of left ventricular dysfunction (LVD). METHODS: 12-lead ECG trace images paired with their echocardiogram reports performed on the same day were selected. A DenseNet121 model, using ECG images as input, was trained to identify EF <50 %. and then externally validated. RESULTS: 1,19,281 ECG-echocardiogram pairs were used for model development. The model demonstrated comparable performance in both the internal test data and external validation data. The area under receiver operating characteristic and precision-recall curves were 0.92 and 0.78, respectively, for the internal test data and 0.88 and 0.74, respectively, for the external validation data. The model accurately identified more than 85 % of cases with EF <50 % in both datasets. CONCLUSIONS: Actual images of ECGs with simple pre-processing and model architecture can be used as a reliable tool to screen for LVD. The use of images expands the reach of these algorithms to geographies with resource and technological limitations.
Gupta MD, Goyal D, Kunal S
… +12 more, Shetty MK, Girish MP, Batra V, Bansal A, Mishra P, Shukla M, Kohli V, Chadha A, Fatima A, Muduli S, Gupta A, Yusuf J
BACKGROUND: Risk stratification is an integral component of ST-segment-elevation myocardial infarction (STEMI) management practices. This study aimed to derive a machine learning (ML) model for risk stratification and id...BACKGROUND: Risk stratification is an integral component of ST-segment-elevation myocardial infarction (STEMI) management practices. This study aimed to derive a machine learning (ML) model for risk stratification and identification of factors associated with in-hospital and 30-day mortality in patients with STEMI and compare it with traditional TIMI score. METHODS: This was a single center prospective study wherein subjects >18 years with STEMI (n = 1700) were enrolled. Patients were divided into two groups: training (n = 1360) and validation dataset (n = 340). Six ML algorithms (Extra Tree, Random Forest, Multiple Perceptron, CatBoost, Logistic Regression and XGBoost) were used to train and tune the ML model and to determine the predictors of worse outcomes using feature selection. Additionally, the performance of ML models both for in-hospital and 30-day outcomes was compared to that of TIMI score. RESULTS: Of the 1700 patients, 168 (9.88 %) had in-hospital mortality while 30-day mortality was reported in 210 (12.35 %) subjects. In terms of in-hospital mortality, Random Forest ML model (sensitivity: 80 %; specificity: 74 %; AUC: 80.83 %) outperformed the TIMI score (sensitivity: 70 %; specificity: 64 %; AUC:70.7 %). Similarly, Random Forest ML model (sensitivity: 81.63 %; specificity: 78.35 %; AUC: 78.29 %) had better performance as compared to TIMI score (sensitivity: 63.26 %; specificity: 63.91 %; AUC: 63.59 %) for 30-day mortality. Key predictors for worse outcomes at 30-days included mitral regurgitation on presentation, smoking, cardiogenic shock, diabetes, ventricular septal rupture, Killip class, age, female gender, low blood pressure and low ejection fraction. CONCLUSIONS: ML model outperformed the traditional regression based TIMI score as a risk stratification tool in patients with STEMI.
AIM: This study was designed to evaluate the safety and effectiveness of the Cocoon Septal Occluder device (Vascular Innovations Co. Nonthaburi, Thailand) for transcatheter closure of isolated secundum type atrial septal...AIM: This study was designed to evaluate the safety and effectiveness of the Cocoon Septal Occluder device (Vascular Innovations Co. Nonthaburi, Thailand) for transcatheter closure of isolated secundum type atrial septal defect (ASD) in Indian patients. METHODS: This was a single-center, retrospective, observational study which included patients who underwent transcatheter closure of isolated secundum ASD using the Cocoon Septal Occluder between April 2014 and May 2023. Follow-up assessments up to one-year were conducted through review of hospital medical records, clinic visits, or via telephonic communication with primary care physicians. RESULTS: A total of 400 patients were included in the study, consisting of 28 paediatric (aged ≤15 years, 8.14 ± 4.41 years) and 372 adult patients (40.83 ± 13.23 years). The mean defect diameter and device size were 16.75 ± 5.85 mm and 20.43 ± 6.24 mm for paediatric patients, and 21.62 ± 6.87 mm and 24.94 ± 7.28 mm for adult patients, respectively. The device was successfully implanted in all paediatric patients, achieving 100 % closure of the defect with no complications, which persisted through one-year follow-up. In the adult cohort, complete ASD closure was achieved in 99.2 % of patients, with two cases of device embolization and one case of device withdrawal. At one-year follow-up, adult patients experienced 0.3 % late device embolization, 0.8 % pericardial effusion/cardiac tamponade, 0.5 % atrioventricular block, and 0.5 % atrial flutter/fibrillation. No cases of endocarditis, haemolysis, nickel allergy, stroke/transient ischemic attack, or migraine were reported in either paediatric or adult patients. CONCLUSION: The results demonstrate that Cocoon Septal Occluder is safe and effective in closing isolated secundum ASD during one-year follow-up.
Cardiovascular diseases are a major cause of death after kidney transplantation. This statement addresses preoperative cardiac decision-making and management with the aim of assessing and reducing the risk of the kidney...Cardiovascular diseases are a major cause of death after kidney transplantation. This statement addresses preoperative cardiac decision-making and management with the aim of assessing and reducing the risk of the kidney transplant surgery. Important issues from a clinician's perspective include the basic cardiovascular workup of these patients, coronary evaluation and management of coronary artery disease, valvular heart disease and left ventricular systolic dysfunction. Recovery left ventricular function after kidney transplant is discussed. In addition, the use of cardiovascular drugs in patients with special emphasis on antiplatelets and anticoagulants in patients planned for kidney transplant is also discussed.
OBJECTIVES: To determine the role of nuclear imaging (NI) in evaluating inconclusive cases with suspicion of infective endocarditis (IE). METHODS: Consecutive patients with an indeterminate diagnosis of IE who underwent...OBJECTIVES: To determine the role of nuclear imaging (NI) in evaluating inconclusive cases with suspicion of infective endocarditis (IE). METHODS: Consecutive patients with an indeterminate diagnosis of IE who underwent labelled leucocyte scintigraphy (LS) or F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) between 2018 and 2021 at 2 reference hospitals in Rio de Janeiro were retrospectively analysed. Subsequent confirmed or rejected diagnoses of IE were evaluated, in addition to clinical and imaging data. Kappa coefficient was used to compared the diagnostic agreement between echocardiographic and NI findings, with a p-value <0.05 considered statistically significant. RESULTS: A total of 85 NI scans (28 FDG-PET/CT, 57 LS) from 76 patients were evaluated, of whom 48 (63.2 %) underwent only LS, 19 (25 %) only FDG-PET/CT, and 9 (11.8 %) both studies. Average age was 63.8 years (SD ± 18.5) and 51.3 % were women. Prosthetic valves were present in 15.8 % of cases, and intracardiac devices in 10.5 %. Among the 76 patients, 18 (23.7 %) had NI findings suggestive of IE. A total of 28 patients (36.8 %) were ultimately diagnosed with IE, 28.6 % of whom had confirmed infections by NI scans. Echocardiographic results had a low level of agreement with NI findings in those diagnosed with IE (kappa = -0.44). CONCLUSIONS: Nuclear imaging contributed to the diagnosis of IE in approximately 30 % of subsequently confirmed cases, which were initially classified as inconclusive by echocardiography. The low level of agreement between these methods underscores their complementary role in the diagnosis of IE, particularly in indeterminate cases.
BACKGROUND AND AIMS: Although F-FDG-PET/CT and CMR are commonly used to diagnose cardiac sarcoidosis(CS), their clinical utility in early-vs. late-stage disease is unclear. The objective of this study was to compare the...BACKGROUND AND AIMS: Although F-FDG-PET/CT and CMR are commonly used to diagnose cardiac sarcoidosis(CS), their clinical utility in early-vs. late-stage disease is unclear. The objective of this study was to compare the diagnostic utility of 18-fluorodeoxyglucose positron emission tomography/computed tomography(F-FDG-PET/CT) and cardiac magnetic resonance imaging(CMR) in patients with early- and late-stage CS. METHODS: Data of 110 consecutive patients with biopsy-proven CS from the Granulomatous Myocarditis Registry were analyzed. All patients underwent F-FDG0PET/CT and CMR within 2 weeks of initial clinical presentation. Patients were divided into early-(<6 months) and late-stage groups based on the time since their first cardiac presentation. Myocardial uptake and late gadolinium enhancement(LGE) were qualitatively and quantitatively assessed. Complete clinical, echocardiographic, and radiological responses were assessed after 4-6 months of immunosuppressive therapy(IST). RESULTS: Among the 102 patients in the final analysis(44.1 ± 10.3 years; LV ejection fraction[LVEF], 43.1 ± 9.5 %),54.9 % and 45.6 % received early and late diagnosis, respectively. Abnormal myocardial uptake on F-FDG-PET/CT 100 %) was observed in all patients with early CS, while only 73.2 % showed LGE on CMR(p < 0.001). The diagnostic yield of F-FDG-PET/CT and CMR was similar in late CS(91.3 %vs.97.8 %,p = 0.498). Patients with early CS had a higher myocardial SUV and more extensive LV involvement than those with late CS. Complete response to IST was more common in patients with early CS than in those with late CS(62.5 %vs.47.8 %,p = 0.019). In the early CS cohort, patients without LGE had a higher rate of complete response following IST than those with LGE (86.7 %vs.53.7 %,p = 0.025). CONCLUSION: In patients with early CS,F-FDG-PET/CT appears to be more sensitive and useful than CMR for diagnosis and assessment of response to IST.
BACKGROUND: Periodontal disease has been associated with chronic heart failure (CHF) and may be an indicator of high risk of adverse cardiovascular outcomes. To date, only few studies have been done and none from India r...BACKGROUND: Periodontal disease has been associated with chronic heart failure (CHF) and may be an indicator of high risk of adverse cardiovascular outcomes. To date, only few studies have been done and none from India regarding the association of periodontal disease in heart failure patients. So, this study was done to assess the prevalence of periodontitis in CHF patients and its correlation with N-terminal pro brain natriuretic peptide (NT- ProBNP). MATERIALS AND METHOD: In this study, 154 patients with stable CHF with left ventricular ejection fraction of less than 40 % were enrolled. All subjects underwent cardiologic and dental evaluations. NT pro-BNP level was measured in all patients. The periodontal screening index was used to quantify the degree of periodontal disease. RESULTS: Gingivitis, moderate periodontitis, and severe periodontitis were present in 48 (31.2 %), 82 (53.2 %), and 24 (15.5 %) patients, respectively. In individuals under the age of 75 years, the study found a significant association between moderate and severe periodontitis and elevated NT-proBNP levels (p < 0.05). The comparison between gingivitis and moderate/severe periodontitis was statistically significant in post hoc analysis. CONCLUSION: CHF patients exhibit a high prevalence of moderate and severe periodontitis. This study highlights a significant association between periodontitis severity and elevated NT-proBNP in CHF patients, underscoring a potential cardiac impact. Further research is warranted to deepen our understanding of this relationship.
The incidence of paravalvular leak (PVL) following surgical valve replacement is 5-17%. Our main aim is to determine the safety and efficacy of percutaneous device closure for significant PVLs.Transcatheter device closur...The incidence of paravalvular leak (PVL) following surgical valve replacement is 5-17%. Our main aim is to determine the safety and efficacy of percutaneous device closure for significant PVLs.Transcatheter device closure was done for 45 PVLs in 42 patients. PVLs were closed percutaneously in mitral position in 23 cases, in aortic position in 20 cases, and combined mitral and aortic leaks in 2 cases. We achieved a technical success rate of 93.33 % and procedural success rate of 91.11%. Transcatheter PVL closure is a safe and effective procedure for symptomatic PVLs.
Kaliyamoorthy D, Mohamed Yusuf M, Ramalingam V
… +7 more, Kasha A, Kathiresan M, Suliankatchi Abdulkader R, Kathiresan J, Mahesh Kumar A, Grace E, Choudhury A
OBJECTIVES: The aim of this observational study was to evaluate the in-hospital and medium-term outcomes of hybrid coronary revascularization (HCR) in the real-world setting compared to conventional coronary artery bypas...OBJECTIVES: The aim of this observational study was to evaluate the in-hospital and medium-term outcomes of hybrid coronary revascularization (HCR) in the real-world setting compared to conventional coronary artery bypass grafting (CABG). METHODS: All patients with multi-vessel coronary artery disease (MV-CAD) who underwent conventional CABG and HCR in our institution between January 2018 to January 2021 were evaluated in terms of length of intensive care unit (ICU), in-hospital stay, repeat revascularization rates, bleeding, stroke, and in-hospital mortality. Clinical outcomes (mortality and major adverse cardiac and cerebrovascular events [MACCE]) were assessed at average follow up of 3.6 years. RESULTS: Pre-procedural characteristics were balanced between the groups after propensity score matching. There was no significant difference in MACCE [Odds ratio: 0.57; 95 % CI: 0.05 to 1.52; p = 0.66], in-hospital mortality [n = 2 (1.9 %) vs n = 0; p = 0.80], post procedure stroke [n = 2 (1.9 %) vs n = 2 (3.7 %); p = 0.86], post-procedural myocardial infarction requiring repeat revascularization [n = 2 (1.9 %) versus n = 1 (1.9 %); p = 1] during the in-hospital stay of the patients in the CABG vs HCR groups respectively. HCR was associated with significantly lower requirement for blood transfusions, bleeding risk, in-hospital stay, and intensive care unit stay. Analysis of the outcomes after 3.6 years revealed no significant difference in MACCE [Odds ratio: 1.40; 95 % CI: 0.46 to 4.30; p = 0.55], and post discharge mortality [n = 0 vs n = 0; p = 1]. Both groups had similar rates of post-procedural myocardial infarction requiring repeat revascularization [n = 0 vs n = 4 (7.4 %); p = 0.278], and rate of re-intervention [n = 0 vs n = 3 (5.6 %); p = 0.41]. CONCLUSION: HCR may be considered as a safe and feasible alternative to conventional CABG in selected individuals with MV-CAD.
BACKGROUND AND OBJECTIVE: Patients with chronic HIV infection face a high risk of premature coronary atherosclerosis, partly due to continuous HAART therapy and susceptibility to opportunistic infections, complicating pe...BACKGROUND AND OBJECTIVE: Patients with chronic HIV infection face a high risk of premature coronary atherosclerosis, partly due to continuous HAART therapy and susceptibility to opportunistic infections, complicating percutaneous coronary intervention (PCI). HIV patients have unique coronary vasculature characteristics. This study aimed to assess the clinical outcomes of PCI using the novel tapered sirolimus-eluting coronary stent (SES) system in HIV patients. METHODS: A prospective, single-arm, non-randomized study was conducted at a tertiary cardiac care center, including 15 HIV-positive patients with acute coronary syndromes. PCI was performed using the study device for de novo coronary lesions with significant size disparity between reference vessel segments. The cumulative incidence of major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, and clinically driven target-lesion revascularization (CD-TLR), was the primary endpoint. RESULTS: Since 2018, 15 HIV-positive patients with a mean age of 50.67 years underwent PCI with the study device. Despite cardiac risk factors and complex lesions, 100 % procedural and device success was achieved by restoring myocardial flow (TIMI flow III). Over a median follow-up of 40 months, no MACE or adverse events were recorded. CONCLUSIONS: This study provides new evidence on the use of the long, tapered SES for treating HIV-positive patients, demonstrating high success rates and favorable long-term outcomes. It is the first report of such outcomes using a long, tapered SES in this population.