Clinical Cardiology最新文献_第3页

Comparison of Standard and Prone-Position Electrocardiograms in COVID-19 Patients With Pulmonary Complications: Correlations and Implications COVID-19 肺部并发症患者标准心电图与俯卧位心电图的比较：相关性和意义

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-30 DOI: 10.1002/clc.70024

Pattarapong Makarawate, Krissanachai Chimtim, Thapanawong Mitsungnern, Pariwat Phungoen, Supap Imoun, Piroon Mootsikapun, Thanat Tangpaisarn, Praew Kotruchin

Background

Previous research highlighted variability in electrocardiogram (ECG) readings across patient positions, particularly in the context of COVID-19 patients with pulmonary complications requiring prone positioning as part of the treatment.

Objective

This study aimed to elucidate the effects of prone positioning on ECG parameters and explore its association with the severity of COVID-19.

Methods

A prospective cohort study involved 60 patients diagnosed with COVID-19 and presenting pulmonary complications. ECGs were recorded in both supine and prone positions, and analyzed for various parameters including heart rate, QRS axis, and QTc interval. Clinical severity was assessed using APACHE II scores and SpO₂/FiO₂ ratios.

Results

Prone positioning led to an increase in heart rate (mean difference: 2.100, 95% CI: 0.471–3.729, p = 0.012), with minor shifts in the QRS axis. Heart rate and QRS axis demonstrated strong positive correlations between positions, with Pearson's correlation coefficients of 0.927 and 0.894, respectively. The study also found a significant association between prolonged QTc intervals in the prone position and elevated APACHE II scores, with a relative risk of 10.75 (95% CI: 1.82–63.64, p = 0.008).

Conclusions

The prone positioning caused minor yet significant changes in heart rate and QRS axis. The correlation of prolonged QTc intervals in the prone position with higher APACHE II scores suggests the prognostic relevance of prone ECG in COVID-19 patients. However, further research is needed to fully understand the clinical implications and mechanisms of these findings.

背景：先前的研究强调了不同体位下心电图读数的差异性，尤其是在COVID-19患者出现肺部并发症需要俯卧位治疗的情况下：本研究旨在阐明俯卧位对心电图参数的影响，并探讨其与 COVID-19 严重程度的关系：这项前瞻性队列研究涉及 60 名确诊为 COVID-19 并出现肺部并发症的患者。在仰卧位和俯卧位记录心电图，并分析心率、QRS 轴和 QTc 间期等各种参数。临床严重程度通过 APACHE II 评分和 SpO2/FiO2 比率进行评估：结果：俯卧位导致心率增加（平均差异：2.100，95% CI：0.471-3.729，P = 0.012），QRS 轴略有移动。心率和 QRS 轴在体位之间显示出很强的正相关性，皮尔逊相关系数分别为 0.927 和 0.894。研究还发现，俯卧位 QTc 间期延长与 APACHE II 评分升高之间存在显著关联，相对风险为 10.75（95% CI：1.82-63.64，P = 0.008）：俯卧位会导致心率和 QRS 轴发生微小但显著的变化。俯卧位 QTc 间期延长与较高的 APACHE II 评分相关，这表明俯卧位心电图与 COVID-19 患者的预后相关。然而，要充分了解这些发现的临床意义和机制，还需要进一步的研究。

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引用次数: 0

Associations Between Cardiovascular Health (Life's Essential 8) and Mental Disorders 心血管健康（人生必修 8）与精神障碍之间的关系。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-24 DOI: 10.1002/clc.70019

Yudi Xu, Wenjing Ning, Yuyuan Zhang, Yuhao Ba, Huimin Liu, Long Liu, Libo Wang, Chunguang Guo, Hui Xu, Siyuan Weng, Zhaokai Zhou, Zongao Cai, Hongxuan Ma, Ge Zhang, Yanjie Jia, Xinwei Han

Background

Mental health was closely associated with cardiovascular disease (CVD). We aimed to investigate the association between cardiovascular health (CVH), as defined by Life's Essential 8 (LE8), and the presence of depression and anxiety.

Hypothesis

We hypothesized that CVH, as defined by LE8, was negatively associated with the prevalence of depression and anxiety.

Methods

A cross-sectional study was conducted on participants (≥ 20 years old) from the National Health and Nutrition Examination Survey (NHANES). The LE8 score (ranging from 0 to 100) was composed of the health behavior score and the health factor score, which were further categorized into three levels as follows: low (0–49), moderate (50–79), and high (80–100). Weighted multivariable logistic regressions and restricted cubic splines were utilized to assess the association between LE8 and mental disorders.

Results

Among the 13 028 participants included in this research, 1206 were determined to have depression symptoms and 2947 were determined to have anxiety symptoms. In the weighted and adjusted model, LE8 was negatively associated with the prevalence of depression (odds ratio [OR], 95% confidence interval [CI]: 0.61, 0.58–0.65) and anxiety (OR, 95% CI: 0.78, 0.75–0.81). Furthermore, a nonlinear dose–response relationship was observed between LE8 and anxiety.

Conclusions

CVH defined by the LE8 was independently and negatively associated with the prevalence of depression and anxiety. Interventions targeting LE8 components may improve both CVH and mental health.

背景：心理健康与心血管疾病（CVD）密切相关。我们的目的是调查生命必备 8（LE8）所定义的心血管健康（CVH）与抑郁和焦虑之间的关系：我们假设，LE8 所定义的心血管健康与抑郁和焦虑的发生率呈负相关：我们对美国国家健康与营养调查（NHANES）的参与者（≥ 20 岁）进行了一项横断面研究。LE8得分（从0到100分不等）由健康行为得分和健康因素得分组成，并进一步分为以下三个等级：低（0-49分）、中（50-79分）和高（80-100分）。利用加权多变量逻辑回归和限制性三次样条来评估LE8与精神障碍之间的关系：在 13 028 名参与研究的人员中，有 1206 人被确定有抑郁症状，2947 人被确定有焦虑症状。在加权调整模型中，LE8 与抑郁症（几率比[OR]，95% 置信区间[CI]：0.61，0.58-0.65）和焦虑症（几率比，95% 置信区间[CI]：0.78，0.75-0.81）的患病率呈负相关。此外，LE8与焦虑之间还存在非线性剂量反应关系：结论：LE8所定义的CVH与抑郁和焦虑的发生率呈负相关。针对 LE8 成分的干预措施可同时改善 CVH 和心理健康。

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引用次数: 0

A Predictive Nomogram of In-Hospital Mortality After 48 h for Atrial Fibrillation Patients in the Coronary Care Unit 冠心病监护病房心房颤动患者 48 小时后院内死亡率预测提名图

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-17 DOI: 10.1002/clc.70017

Wenhui Wang, Linlin Liu, Lu Jin, Bo Hu

Background

Patients with atrial fibrillation (AF) suffer a higher risk of death, and it is necessary to develop prediction tools for mortality risk in critically ill patients with AF. This study aimed to develop a novel predictive nomogram of in-hospital mortality after 48 h in the coronary care unit (CCU) for patients with AF.

Methods

We collected information on CCU patients with AF from the “Medical Information Mart for Intensive Care-III” database and developed a nomogram model for predicting the all-cause mortality risk after 48 h in the hospital. Key variables were selected by univariate logistic and least absolute shrinkage and selection operator regression. The independent predictors with p < 0.05 were screened out by multivariate logistic regression. A predictive nomogram was constructed using these independent predictors, and the model calibration and discrimination were evaluated.

Results

This study finally enrolled 1248 CCU patients with AF, and the in-hospital mortality was 17% (209/1248). The predictive nomogram was constructed by 13 selected independent predictors, including age, smoking status, acute kidney injury, chronic obstructive pulmonary disease, ventricular arrhythmia, shock, urea, red cell distribution width, leucocytosis, continuous renal replacement therapy, continuous positive airway pressure, anticoagulation, and heart rate. The area under the curve of the nomogram was 0.803 (95% confidence interval 0.771–0.835). The nomogram was verified to have good accuracy and calibration.

Conclusions

This study developed a novel nomogram containing age, acute kidney injury, and heart rate that can be a good predictor of potential in-hospital mortality after 48 h in CCU patients with AF.

背景心房颤动（房颤）患者的死亡风险较高，因此有必要开发预测房颤重症患者死亡风险的工具。本研究旨在开发一种新型的冠心病监护病房（CCU）房颤患者 48 小时后院内死亡率预测提名图。方法我们从 "Medical Information Mart for Intensive Care-III "数据库中收集了冠心病监护病房心房颤动患者的信息，并建立了一个预测住院 48 小时后全因死亡风险的提名图模型。通过单变量逻辑回归、最小绝对缩减回归和选择算子回归筛选出关键变量。通过多变量逻辑回归筛选出 p < 0.05 的独立预测因子。利用这些独立预测因子构建了预测提名图，并对模型的校准和区分度进行了评估。结果该研究最终纳入了 1248 名 CCU 房颤患者，院内死亡率为 17%（209/1248）。预测提名图由 13 个选定的独立预测因子构建，包括年龄、吸烟状况、急性肾损伤、慢性阻塞性肺疾病、室性心律失常、休克、尿素、红细胞分布宽度、白细胞增多症、持续肾脏替代治疗、持续气道正压、抗凝和心率。提名图的曲线下面积为 0.803（95% 置信区间为 0.771-0.835）。该提名图具有良好的准确性和校准性。结论本研究开发了一种包含年龄、急性肾损伤和心率的新型提名图，可以很好地预测 CCU 房颤患者 48 小时后的潜在院内死亡率。

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引用次数: 0

Anticoagulant Impact on Clinical Outcomes of Pulmonary Embolism Compared With Thrombolytic Therapy; Meta-Analysis 与溶栓疗法相比，抗凝剂对肺栓塞临床疗效的影响；Meta 分析

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-12 DOI: 10.1002/clc.70016

Yang Su, Dongmei Zou, Yi Liu, Chaoqun Wen, Xialing Zhang

Background

Pulmonary embolism (PE) is a critical condition requiring effective management strategies. Several options are available, including thrombolytic therapy and anticoagulants.

Objectives

To assess the impact of thrombolytic therapy either combined with anticoagulant (AC) or alone versus AC alone on mortality, recurrence, clinical deterioration, bleeding, and hospital stay.

Method

This study included 25 previously published studies from 1990 to 2023, with a total of 12 836 participants. Dichotomous and continuous analysis models were used to evaluate outcomes, with heterogeneity and publication bias tests applied. A random model was used for data analysis. Several databases were searched for the identification and inclusion of studies, such as Ovid, PubMed, Cochrane Library, Google Scholar, and Embase.

Results

For sub-massive PE, CDT plus AC significantly reduced in-hospital, 30-day, and 12-month mortality compared to AC alone, odds ratio (OR) of −0.99 (95% CI [−1.32 to −0.66]), with increased major bleeding risk but no difference in minor bleeding or hospital stay, OR = 0.46, 95% CI [−0.03 to 0.96]). For acute intermediate PE, systemic thrombolytic therapy did not affect all-cause or in-hospital mortality but increased minor bleeding, reduced recurrent PE, and prevented clinical deterioration. The heterogeneity of different models in the current study varied from 0% to 37.9%.

Conclusion

The addition of CDT to AC improves mortality outcomes for sub-massive PE but raises the risk of major bleeding. Systemic thrombolytic therapy reduces recurrence and clinical decline in acute intermediate PE despite increasing minor bleeding. Individualized patient assessment is essential for optimizing PE management strategies.

背景肺栓塞（PE）是一种危重病，需要有效的治疗策略。目前有多种方法可供选择，包括溶栓疗法和抗凝剂。目的评估溶栓疗法与抗凝剂（AC）联合或单独使用对死亡率、复发、临床恶化、出血和住院时间的影响。方法本研究纳入了 25 项先前发表的研究，时间跨度从 1990 年到 2023 年，共有 12 836 名参与者。采用二分法和连续分析模型评估结果，并进行了异质性和发表偏倚检验。数据分析采用随机模型。为了识别和纳入研究，研究人员检索了多个数据库，如 Ovid、PubMed、Cochrane Library、Google Scholar 和 Embase。结果对于亚重度 PE，与单用 AC 相比，CDT 加 AC 能显著降低院内、30 天和 12 个月的死亡率，几率比（OR）为-0.99（95% CI [-1.32 to -0.66]），大出血风险增加，但小出血或住院时间无差异，OR = 0.46，95% CI [-0.03 to 0.96]）。对于急性中型 PE，全身溶栓治疗不会影响全因死亡率或院内死亡率，但会增加轻微出血、减少复发性 PE 并防止临床恶化。本研究中不同模型的异质性从 0% 到 37.9% 不等。结论在 AC 基础上加用 CDT 可改善亚严重 PE 的死亡率，但会增加大出血的风险。全身溶栓治疗可减少急性中型 PE 的复发和临床衰退，尽管会增加轻微出血。对患者进行个体化评估对于优化 PE 管理策略至关重要。

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引用次数: 0

Is There a Need for Sex-Tailored Lipoprotein(a) Cut-Off Values for Coronary Artery Disease Risk Stratification? 在冠状动脉疾病风险分层中，是否需要考虑性别因素的脂蛋白（a）临界值？

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-12 DOI: 10.1002/clc.70012

Ece Yurtseven, Dilek Ural, Erol Gursoy, Bekay Omer Cunedioglu, Orhan Ulas Guler, Kemal Baysal, Saide Aytekin, Vedat Aytekin, Meral Kayakcioglu

Background

Lipoprotein(a) [Lp(a)] plasma level is a well-known risk factor for coronary artery disease (CAD). Existing data regarding the influence of sex on the Lp(a)-CAD relationship are inconsistent.

Objective

To investigate the relationship between Lp(a) and CAD in men and women and to elucidate any sex-specific differences that may exist.

Methods

Data of patients with Lp(a) measurements who were admitted to a tertiary university hospital, Koc University Hospital, were analyzed. The relationship between Lp(a) levels and CAD was explored in all patients and in subgroups created by sex. Two commonly accepted Lp(a) thresholds ≥ 30 and ≥ 50 mg/dL were analyzed.

Results

A total of 1858 patients (mean age 54 ± 17 years; 53.33% females) were included in the analysis. Lp(a) was an independent predictor of CAD according to the multivariate regression model for the entire cohort. In all cohort, both cut-off values (≥ 30 and ≥ 50 mg/dL) were detected as independent predictors of CAD (p < 0.001). In sex-specific analysis, an Lp(a) ≥ 30 mg/dL was an independent predictor of CAD only in women (p < 0.001), but Lp(a) ≥ 50 mg/dL was a CAD predictor both in men and women (men, p = 0.004; women, p = 0.047).

Conclusion

The findings of this study may suggest that different thresholds of Lp(a) level can be employed for risk stratification in women compared to men.

背景脂蛋白（a）[Lp（a）]血浆水平是众所周知的冠状动脉疾病（CAD）风险因素。关于性别对脂蛋白（a）与冠状动脉疾病关系的影响，现有数据并不一致。目的研究男性和女性脂蛋白（a）与冠状动脉粥样硬化之间的关系，并阐明可能存在的性别差异。方法分析科克大学医院（Koc University Hospital）这所三级甲等医院收治的 Lp(a) 测量患者的数据。研究了所有患者以及按性别划分的亚组中脂蛋白（a）水平与 CAD 之间的关系。对两种普遍接受的脂蛋白（a）阈值（≥ 30 和 ≥ 50 mg/dL）进行了分析。结果共有 1858 名患者（平均年龄为 54 ± 17 岁；女性占 53.33%）被纳入分析。根据整个队列的多变量回归模型，脂蛋白（a）是预测 CAD 的独立指标。在所有队列中，两个临界值（≥ 30 和 ≥ 50 mg/dL）都是预测 CAD 的独立因素（p < 0.001）。在性别特异性分析中，脂蛋白（a）≥ 30 毫克/分升仅是女性患 CAD 的独立预测因子（p < 0.001），但脂蛋白（a）≥ 50 毫克/分升是男性和女性患 CAD 的预测因子（男性，p = 0.004；女性，p = 0.047）。结论本研究结果表明，与男性相比，女性可采用不同的脂蛋白（a）水平阈值进行风险分层。

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引用次数: 0

The Impact of Body Mass Index on the Mortality of Myocardial Infarction Patients With Nonobstructive Coronary Arteries 身体质量指数对冠状动脉非阻塞性心肌梗死患者死亡率的影响

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-11 DOI: 10.1002/clc.70013

Chaohui Dong, Mustafa Kacmaz, Clara Schlettert, Mohammad Abumayyaleh, Ibrahim Akin, Rayyan Hemetsberger, Andreas Mügge, Assem Aweimer, Nazha Hamdani, Ibrahim El-Battrawy

Objectives

Myocardial infarction without significant stenosis or occlusion of the coronary arteries carries a high risk of recurrent major adverse cardiovascular events and poor prognosis. This study aimed to investigate the association between body mass index and outcomes in patients with a suspected myocardial infarction with nonobstructive coronary artery disease (MINOCA).

Methods

Patients were recruited at Bergmannsheil University Hospital from January 2010 to April 2021. The primary outcomes were in-hospital and long-term mortality. Secondary outcomes consisted of adverse events during hospitalization and during follow-up.

Results

A total of 373 patients were included in the study, with a mean follow-up time of 6.2 years. The patients were divided into different BMI groups: < 25 kg/m² (n = 121), 25−30 kg/m² (n = 140), and > 30 kg/m² (n = 112). In-hospital mortality was 1.7% versus 2.1% versus 4.5% (p = 0.368). However, long-term mortality tended to be higher in the < 25 kg/m² group compared to the 25−30 and > 30 kg/m² groups (log-rank p = 0.067). Subgroup analysis using Kaplan−Meier analysis showed a higher rate of cardiac cause of death in the < 25 kg/m² group compared to the 25−30 and > 30 kg/m² groups: 5.7% versus 1.1% versus 0.0% (log-rank p = 0.042). No significant differences were observed in other adverse events between the different BMI groups during hospitalization and long-term follow-up.

Conclusions

Patients with a BMI < 25 kg/m² who experience a suspected myocardial infarction without significant coronary artery disease may have higher all-cause mortality and cardiovascular cause of death. However, further data are needed to confirm these findings.

目的冠状动脉无明显狭窄或闭塞的心肌梗死患者极易复发重大不良心血管事件，且预后较差。本研究旨在探讨疑似心肌梗死伴非阻塞性冠状动脉疾病（MINOCA）患者的体重指数与预后之间的关系。方法 Bergmannsheil 大学医院于 2010 年 1 月至 2021 年 4 月期间招募患者。主要结果为院内死亡率和长期死亡率。次要结果包括住院期间和随访期间的不良事件。结果共有373名患者参与研究，平均随访时间为6.2年。患者被分为不同的体重指数组：< 25 kg/m²（n = 121）、25-30 kg/m²（n = 140）和> 30 kg/m²（n = 112）。院内死亡率为 1.7% 对 2.1% 对 4.5% （P = 0.368）。然而，与 25-30 kg/m² 组和 > 30 kg/m² 组相比，< 25 kg/m² 组的长期死亡率往往更高（log-rank p = 0.067）。使用卡普兰-米尔分析法进行的亚组分析表明，与 25-30 公斤/平方米组和 30 公斤/平方米组相比，< 25 公斤/平方米组的心源性死亡率更高：5.7% 对 1.1% 对 0.0%（对数秩 p = 0.042）。在住院期间和长期随访期间，不同体重指数组之间在其他不良事件方面没有观察到明显差异。结论 BMI≥lt; 25 kg/m² 的患者在没有明显冠状动脉疾病的情况下发生疑似心肌梗死，其全因死亡率和心血管疾病致死率可能较高。然而，还需要更多数据来证实这些发现。

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引用次数: 0

Bridging With Low-Molecular-Weight Heparin Versus Antiplatelet Therapy in Patients Undergoing Noncardiac Surgery After Percutaneous Coronary Intervention: A Comprehensive Review 经皮冠状动脉介入术后接受非心脏手术患者的低分子量肝素桥接疗法与抗血小板疗法：全面回顾

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-11 DOI: 10.1002/clc.70008

Syed Javaid Iqbal, Zulfiqar Qutrio Baloch, Jahanzeb Malik, Nikeeta Bhimani, Amin Mehmoodi, Vishal Gupta

Background

This review article discussed the use of bridging therapy with low-molecular-weight heparin (LMWH) in patients who undergo noncardiac surgery (NCS) after percutaneous coronary intervention (PCI).

Hypotheses

Patients who undergo PCI are at an increased risk of thrombotic events due to their underlying cardiovascular disease. However, many of these patients may require NCS at some point in their lives, which poses a significant challenge for clinicians as they balance the risk of thrombotic events against the risk of bleeding associated with antithrombotic therapy.

Results

This review evaluates the current evidence on the use of bridging therapy with LMWH in patients undergoing NCS after PCI, focusing on outcomes related to the efficacy and safety of antithrombotic therapy. The article also discusses the limitations of the current evidence and highlights areas where further research is needed to optimize the management of antithrombotic therapy in this patient population.

Conclusion

The goal of this review was to provide clinicians with a comprehensive summary of the available evidence to guide clinical decision-making and improve patient outcomes.

背景本文综述了经皮冠状动脉介入治疗（PCI）后接受非心脏手术（NCS）的患者使用低分子量肝素（LMWH）进行桥接治疗的情况。假设接受 PCI 的患者因其潜在的心血管疾病而增加了发生血栓事件的风险。然而，这些患者中的许多人可能在其生命的某个阶段需要接受 NCS，这给临床医生带来了巨大的挑战，因为他们需要平衡血栓事件的风险和抗血栓治疗相关的出血风险。结果本综述评估了PCI术后接受NCS的患者使用LMWH进行桥接治疗的现有证据，重点关注与抗血栓治疗的疗效和安全性相关的结果。文章还讨论了现有证据的局限性，并强调了需要进一步研究的领域，以优化此类患者的抗血栓治疗管理。结论本综述旨在为临床医生提供现有证据的全面总结，以指导临床决策并改善患者预后。

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引用次数: 0

Application Value and Safety Analysis of Warfarin, Rivaroxaban, and Dabigatran Ester in Elderly Patients With Atrial Fibrillation 华法林、利伐沙班和达比加群酯在老年房颤患者中的应用价值和安全性分析

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-09 DOI: 10.1002/clc.70014

Cheng Chen, Qing Tian, Chong Cheng, Xixin Ji, Mengyun Feng, Huiqun Tan, Qian Zhou

Background

This study aimed to evaluate the application value and safety of Warfarin, Rivaroxaban, and Dabigatran in elderly patients with atrial fibrillation.

Methods

A total of 180 elderly patients with atrial fibrillation admitted to our hospital were retrospectively analyzed. According to their anticoagulant treatment regimen, patients were divided into three groups: Warfarin (57 cases), Rivaroxaban (61 cases), and Dabigatran (62 cases). General demographic information was collected, and coagulation function indicators—including fibrinogen (FIB), thrombin time (PT), activated partial thrombin time (APTT), and D-dimer (D-D)—as well as liver function indexes—including total bilirubin (TbiL), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine transferase (ALT)—were compared before and after 4 weeks of treatment.

Results

There were no significant differences in demographic characteristics such as gender, age, body mass index, or disease course among the three groups. The total effective rate in the Warfarin group (84.21%) was significantly lower than in the Rivaroxaban (98.36%) and Dabigatran (96.77%) groups (p < 0.05). However, there was no significant difference in the total effective rate between the Rivaroxaban and Dabigatran groups (p > 0.05). Additionally, no significant differences were found in the effects of the three drugs on coagulation function, liver function, or the incidence of bleeding (p = 0.052).

Conclusion

Warfarin, Rivaroxaban, and Dabigatran can effectively prevent thrombosis in elderly patients with atrial fibrillation, with Rivaroxaban and Dabigatran showing superior effectiveness. All three drugs demonstrated similar low rates of bleeding events and had no significant impact on coagulation and liver function.

研究背景本研究旨在评估华法林、利伐沙班和达比加群在老年房颤患者中的应用价值和安全性：回顾性分析我院收治的 180 例老年房颤患者。根据抗凝治疗方案，患者被分为三组：华法林（57 例）、利伐沙班（61 例）和达比加群（62 例）。收集一般人口统计学信息，并比较治疗 4 周前后的凝血功能指标（包括纤维蛋白原（FIB）、凝血酶时间（PT）、活化部分凝血酶时间（APTT）和 D-二聚体（D-D））以及肝功能指标（包括总胆红素（TbiL）、碱性磷酸酶（ALP）、天门冬氨酸氨基转移酶（AST）和丙氨酸转移酶（ALT））：三组患者的性别、年龄、体重指数或病程等人口统计学特征无明显差异。华法林组的总有效率（84.21%）明显低于利伐沙班组（98.36%）和达比加群组（96.77%）（P 0.05）。此外，三种药物对凝血功能、肝功能和出血发生率的影响无明显差异（P = 0.052）：结论：华法林、利伐沙班和达比加群可有效预防老年心房颤动患者的血栓形成，其中利伐沙班和达比加群有更好的疗效。这三种药物的出血事件发生率都很低，对凝血功能和肝功能没有明显影响。

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引用次数: 0

Low-Density Lipoprotein Cholesterol, Cardiovascular Risk Factors, and Predicted Risk in Young Adults 年轻人的低密度脂蛋白胆固醇、心血管风险因素和预测风险。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-09 DOI: 10.1002/clc.70009

Alexander R. Zheutlin, Samuel Luebbe, Alexander Chaitoff, Eric L. Stulberg, John T. Wilkins

Background

Young adults with elevated LDL-C may experience increased burden of additional cardiovascular disease (CVD) risk factors. It is unclear how much LDL-C levels, a modifiable factor, correlate with non-LDL-C CVD risk factors among young adults or how strongly these CVD risk factors are associated with long-term predicted CVD risk. We quantified clustering of non-LDL-C CVD risk factors by LDL-C among young adults to assess the association between non-LDL-C and LDL-C risk factors with predicted CVD risk in young adults.

Methods

The current analysis is a cross-sectional study of adults < 40 years with an LDL-C< 190 mg/dL participating in the National Health and Nutrition Examination Survey (NHANES) between January 2015 and March 2020. We measured the prevalence of non-LDL-C risk factors by LDL-C and association between LDL-C and non-LDL-C risk factors with predicted risk of CVD by the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations.

Results

Among 2108 young adults, the prevalence of LDL-C ≥ 130 mg/dL was 15.5%. Compared with young adults with LDL-C < 100 mg/dL, those with LDL-C 100–< 130, 130–< 160, and 160–< 190 mg/dL had greater non-LDL-C risk factors. Both LDL-C and non-LDL-C risk factors were independently associated with a 30-year risk of CVD (OR 1.05, 95% CI 1.03–1.07 and OR 1.17, 95% CI 1.12–1.23, respectively). The association of LDL-C and 30-year risk did not vary by non-LDL-C risk factor burden (p_interaction = 0.43).

Conclusion

Non-LDL-C risk factors cluster among increasing levels of LDL-C in young adults. Greater guidance on how to manage cardiovascular risk factors in young adults is needed.

背景：低密度脂蛋白胆固醇（LDL-C）升高的青壮年可能会增加额外的心血管疾病（CVD）风险因素的负担。目前还不清楚低密度脂蛋白胆固醇水平（一种可改变的因素）与青壮年非低密度脂蛋白胆固醇心血管疾病风险因素的相关性有多大，也不清楚这些心血管疾病风险因素与长期预测心血管疾病风险的相关性有多大。我们对青壮年非低密度脂蛋白胆固醇心血管疾病风险因素按低密度脂蛋白胆固醇的聚类进行了量化，以评估非低密度脂蛋白胆固醇和低密度脂蛋白胆固醇风险因素与青壮年预测心血管疾病风险之间的关联：本次分析是一项针对成年人的横断面研究：在 2108 名年轻成年人中，低密度脂蛋白胆固醇≥ 130 mg/dL 的患病率为 15.5%。与低密度脂蛋白胆固醇交互作用=0.43的青壮年相比）：结论：非低密度脂蛋白胆固醇风险因素聚集在低密度脂蛋白胆固醇水平升高的青壮年中。需要就如何管理青壮年心血管风险因素提供更多指导。

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引用次数: 0

Impact of Immediate Versus Staged Complete Revascularization on Short-Term and Long-Term Clinical Outcomes in Patients With Acute Coronary Syndrome and Multivessel Disease: A Systematic Review and Meta-Analysis 急性冠状动脉综合征和多血管疾病患者立即完全血管重建与分阶段完全血管重建对短期和长期临床结果的影响：系统综述与元分析》。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-04 DOI: 10.1002/clc.70011

Qiufeng Jia, Ankai Zuo, Chengrui Zhang, Danning Yang, Yu Zhang, Jing Li, Fengshuang An

Background

In patients with acute coronary syndrome (ACS) and multivessel disease (MVD), complete revascularization (CR) improves prognosis. This meta-analysis, summarizing recent RCTs, contrasts short-term and long-term clinical outcomes between immediate complete revascularization (ICR) and staged complete revascularization (SCR).

Methods

We systematically searched the online database and eight RCTs were involved. The primary outcomes included long-term unplanned ischemia-driven revascularization, re-infarction, combined cardiovascular (CV) death or myocardial infarction (MI), all-cause death, CV death, stroke, and hospitalization for heart failure (HHF). The secondary outcomes were 1-month unplanned ischemia-driven revascularization, re-infarction, all-cause death, and CV death. Safety endpoints included stent thrombosis and major bleeding.

Results

Eight RCTs comprising 5198 patients were involved. ICR reduced long-term unplanned ischemia-driven revascularization (RR 0.64, 95% CI 0.51–0.81, p < 0.001), combined CV death or MI (HR 0.51, 95% CI 0.34–0.78, p = 0.002), and re-infarction (RR 0.66,95% CI 0.48 to 0.91, p = 0.012) compared with SCR. ICR also decreased 1-month unplanned ischemia-driven revascularization (RR 0.41, 95% CI: 0.21–0.77, p = 0.006) and re-infarction (RR 0.33, 95% CI:0.15–0.74, p = 0.007) but increased 1-month all-cause death (RR 2.22, 95% CI 1.06–4.65, p = 0.034).

Conclusion

In ACS patients with MVD, we first found that ICR significantly lowered the risk of both short-term and long-term unplanned ischemia-driven revascularization and re-infarction, as well as the long-term composite outcome of CV death or MI compared with SCR. However, there may be an increase in 1-month all-cause death in the ICR group.

背景：对于急性冠状动脉综合征（ACS）和多血管疾病（MVD）患者，完全血运重建（CR）可改善预后。这项荟萃分析总结了近期的研究数据，对比了立即完全血管再通（ICR）和分阶段完全血管再通（SCR）的短期和长期临床结果：方法：我们系统地搜索了在线数据库，共涉及 8 项研究。主要结果包括长期非计划缺血驱动血管再通、再梗死、合并心血管（CV）死亡或心肌梗死（MI）、全因死亡、CV死亡、中风和心衰住院（HHF）。次要结局为1个月内非计划性缺血驱动血管再通、再梗死、全因死亡和CV死亡。安全性终点包括支架血栓形成和大出血：结果：8项研究共涉及5198名患者。ICR减少了长期非计划缺血驱动的血管再通术（RR 0.64，95% CI 0.51-0.81，p 结论：ICR减少了长期非计划缺血驱动的血管再通术（RR 0.64，95% CI 0.51-0.81，p在患有 MVD 的 ACS 患者中，我们首先发现，与 SCR 相比，ICR 能显著降低短期和长期计划外缺血驱动血管再通和再梗死的风险，以及心血管死亡或心肌梗死的长期综合结局。不过，ICR 组 1 个月内全因死亡人数可能会增加。

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引用次数: 0