Participants in this arm will receive comprehensive periodontal health interventions, including:

1. Full periodontal evaluation using dental mirrors and probes (assessing visible plaque, probing depth, bleeding on probing, and attachment loss).
2. Supragingival scaling, root planing, and professional plaque removal.
3. Temporary restoration of carious lesions and extraction of root remnants, as needed.
4. Personalized oral hygiene instruction, including the use of multi-tufted brushes, toothpaste, floss, and interdental brushes.

Participants in this arm will receive standard care without specific periodontal interventions. This includes routine medical management for myocardial infarction, as per standard clinical guidelines, without structured periodontal treatment.

In the intervention group, patients underwent a comprehensive periodontal evaluation conducted by periodontists at a dental clinic. All permanent teeth, except for third molars, were assessed using dental mirrors and periodontal probes. Each tooth was examined at four sites (vestibular, distal, lingual, and mesial) to evaluate visible plaque, probing depth, probing bleeding, and attachment loss.

During the first treatment session, patients were provided with information about periodontal disease, emphasizing the importance of controlling supragingival bacterial biofilms for successful treatment. Plaque-retentive factors (calculus) were removed. Temporary materials were used to restore carious lesions, root remnants were extracted, and maladaptive restorations were adjusted. Supragingival calculus was removed using periodontal scalers, followed by cleaning with a rubber cup, prophylaxis paste, dental floss, and/or interdental brushes. No prophylactic antibiotics were used prior to the

The ejection fraction (EF) changed by 10% half a year after surgery

The outcome will be assessed by measuring the level of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker reflecting cardiac stress and heart failure.