A drug-coated balloon (DCB) strategy has become an established option for de novo coronary lesions, offering the advantage of avoiding permanent implants. However, very long-term vascular changes after stentless percutaneous coronary intervention (PCI) remain insufficiently characterized. We report a case of chronic total occlusion that developed eight years after DCB angioplasty for a diffuse long right coronary artery lesion in a patient with unstable angina. A 65-year-old man developed exertional chest discomfort approximately seven years after the index procedure, and cardiac computed tomography demonstrated severe calcification and suspected occlusion of the previously treated segment. At the index procedure, we selected a DCB-only strategy because intravascular ultrasound (IVUS) revealed a long, diffuse lesion requiring multiple stents and extensive drug-eluting stent (DES) implantation carries increased long-term risks. During repeat PCI, IVUS demonstrated dense calcification and high-echoic crescentic neointimal tissue without imaging features suggestive of thrombus. The imaging findings suggested atherosclerotic progression, potentially compounded by the limited acute luminal gain achieved at the index procedure, the cumulative burden of cardiovascular risk factors, and chronic inflammatory cell infiltration. Although the pharmacological effect of paclitaxel diminishes within months, preclinical studies have suggested that low residual tissue concentrations might contribute to late fibrotic or calcific remodeling. Device-related neoatherosclerosis appears unlikely because of the absence of a metallic scaffold. This case illustrates the multifactorial nature of very late vascular changes after stentless PCI and demonstrates how multimodality imaging, including cardiac computed tomography and IVUS, can describe late lesion morphology and healing patterns. The findings highlight the complex late-phase vascular morphology that may emerge in patients with diffuse disease and multiple risk factors and underscore the clinical value of comprehensive imaging assessment at very late follow-up.

Fabry disease (FD) is a rare X-linked lysosomal storage disorder and also a rare cause of coronary stenosis. We present a case of coronary stenosis in a 39-year-old man with FD, including optical coherence tomography (OCT) imaging findings.

Background: Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide, with particularly poor outcomes in low-resource settings. Contemporary prospective data on short-term outcomes and their predictors remain scarce in Ethiopia. This study aimed to describe the clinical characteristics of patients with ACS, determine seven-day mortality, and identify independent predictors of seven-day mortality at Jimma University Medical Center, Southwest Ethiopia. Methods: A prospective hospital-based cohort study was conducted among 200 consecutive adult patients admitted with ACS between September 2024 and September 2025. Sociodemographic, clinical, laboratory, electrocardiographic, echocardiographic, treatment, and outcome data were collected using a structured case report form. Seven-day mortality was the primary outcome. Kaplan-Meier analysis was used to estimate survival probabilities, and bivariable and multivariable logistic regression analyses were performed to identify independent predictors of seven-day mortality. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) are reported, and statistical significance was defined as p < 0.05. Results: Among the 200 participants, 75.5% were male and 61.5% were urban residents. The median age was 58 years (interquartile range [IQR], 48-68 years). ST-segment elevation myocardial infarction was the predominant ACS subtype (78.0%), followed by non-ST-segment elevation myocardial infarction (11.5%) and unstable angina (10.5%). Overall, 60 patients (30.0%) died within seven days of admission. After adjustment for potential confounders, diabetes mellitus (AOR, 17.93; 95% CI [3.44-93.42]; p = 0.001), advancing age (AOR, 1.23 per year; 95% CI [1.11-1.38]; p < 0.001), higher baseline troponin concentration (AOR, 1.41 ng/mL; 95% CI [1.19-1.67]; p < 0.001), and Killip class IV at presentation (AOR, 69.50; 95% CI [4.54-1065.01]; p = 0.002) were independently associated with increased odds of seven-day mortality. Conclusion: Seven-day mortality among patients with ACS at Jimma University Medical Center was substantial. Advancing age, diabetes mellitus, elevated baseline troponin, and Killip class IV independently predicted seven-day mortality. These findings underscore the importance of early risk stratification, prompt recognition of hemodynamic compromise, and timely implementation of evidence-based management strategies to improve short-term outcomes in resource-limited settings.

Although gut microbiota dysbiosis is associated with coronary artery disease (CAD), its dynamic alterations across distinct clinical stages remain largely unexplored. This study aimed to identify stage-specific microbial biomarkers across the CAD spectrum. We analyzed 16S rRNA sequencing data from 306 subjects, including non-CAD controls and patients with mild coronary stenosis (MCS), stable angina (SA), unstable angina (UA), and acute myocardial infarction (AMI). Diversity analyses, machine learning, and SPIEC-EASI network modeling were applied to evaluate microbial community shifts and identify core diagnostic markers. Significant structural remodeling of the gut microbiota was observed, particularly during the AMI stage. Veillonella, Intestinimonas, and Streptococcus were identified as the core biomarkers for the MCS, SA, and UA/AMI stages, respectively. From the MCS to the UA stage, ecological network connectivity continuously declined, highlighting critical barrier vulnerability, before transitioning into an antagonism-dominated network in the AMI stage. Machine learning models effectively discriminated among the various disease stages, and key microbial markers remained statistically robust after adjusting for major clinical confounders. The gut microbiota exhibits dynamic, stage-specific dysbiosis throughout CAD progression, providing promising non-invasive biomarkers for precise disease staging and diagnosis.