Clinical Cardiology最新文献_第7页

Nonvitamin K Anticoagulants: Risk of Bleeding When Interacting With Other Medications: A Cohort Study From Medicare 非维生素 K 抗凝剂：与其他药物相互作用时的出血风险：来自医疗保险的队列研究。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-03 DOI: 10.1002/clc.70023

Ainhoa Gomez-Lumbreras, Madeline Brendle, Krystal Moorman-Bishir, Malinda Tan, Daniel C. Malone

Introduction

Patients on nonvitamin K antagonist (NVKA) are usually taking other drugs. Potential interaction may increase the gastrointestinal (GI) bleeding risk associated with NVKA.

Methods

Observational cohort study using Medicare data from 2017 to 2020. Participants receiving a NVKA were included. A concomitant overlapping period while on NVKA was assessed for nonsteroidal anti-inflammatory drugs (NSAIDS), selective serotonin reuptake inhibitors (SSRI), antiplatelets, glucocorticoids, aspirin and proton pump inhibitors (PPI). A logistic regression predicting either any bleeding or GI bleeding was conducted estimating the odds ratio (OR) and 95% confidence interval (CI).

Results

A total of 102 531 people on NVKA with mean age 77 years (SD = 9.8) and 55% females (N = 56 671) were included. Previous history of GI bleeding occurred in 2 908 (2.8%) participants, concomitant exposure to PPI occurred in 38 713 (38%), SSRI in 16 487 (16%), clopidogrel in 15 795 (15.4%), NSAIDs in 13 715 (13.4%) and glucocorticoids in 13 715 (13.4%). Risk for any bleeding was shown for clopidogrel (OR: 1.37, 95% CI: 1.30, 1.44), prasugrel/ticagrelor (OR: 1.36, 95% CI: 1.18, 1.58), glucocorticoids (OR: 1.26, 95% CI: 1.19, 1.34), and SSRIs (OR: 1.13, 95% CI: 1.07, 1.19). GI bleeding risk was shown for clopidogrel (OR: 1.44, 95% CI: 1.34, 1.55), prasugrel/ticagrelor (OR: 1.47, 95% CI: 1.20, 1.79), SSRIs (OR: 1.09, 95% CI: 1.01, 1.17) and glucocorticoids (OR: 1.33, 95% CI: 1.23, 1.44). PPI use was correlated with both NSAID (r = 0.07, p ≤ 0.0001) and SSRI use (r = 0.09, p ≤ 0.0001).

Conclusion

NVKA concomitantly taken with antiplatelets, glucocorticoids, and SSRIs showed an increased risk for any bleeding and GI bleeding.

简介服用非维生素K拮抗剂（NVKA）的患者通常还在服用其他药物。潜在的相互作用可能会增加与 NVKA 相关的胃肠道（GI）出血风险：使用 2017 年至 2020 年的医疗保险数据进行观察性队列研究。纳入接受 NVKA 的参与者。在服用 NVKA 期间，评估了非甾体抗炎药（NSAIDS）、选择性血清素再摄取抑制剂（SSRI）、抗血小板药物、糖皮质激素、阿司匹林和质子泵抑制剂（PPI）的同时重叠期。对任何出血或消化道出血的预测进行了逻辑回归，估算出了几率比（OR）和 95% 的置信区间（CI）：共纳入 102 531 名服用 NVKA 的患者，平均年龄 77 岁（SD = 9.8），55% 为女性（N = 56 671）。2 908人（2.8%）曾有消化道出血史，38 713人（38%）同时服用过PPI，16 487人（16%）服用过SSRI，15 795人（15.4%）服用过氯吡格雷，13 715人（13.4%）服用过非甾体抗炎药，13 715人（13.4%）服用过糖皮质激素。氯吡格雷（OR：1.37，95% CI：1.30，1.44）、普拉格雷/替卡格雷（OR：1.36，95% CI：1.18，1.58）、糖皮质激素（OR：1.26，95% CI：1.19，1.34）和 SSRIs（OR：1.13，95% CI：1.07，1.19）均有任何出血风险。氯吡格雷（OR：1.44，95% CI：1.34，1.55）、普拉格雷/替卡格雷（OR：1.47，95% CI：1.20，1.79）、SSRIs（OR：1.09，95% CI：1.01，1.17）和糖皮质激素（OR：1.33，95% CI：1.23，1.44）均有消化道出血风险。PPI的使用与非甾体抗炎药（r = 0.07，p ≤ 0.0001）和SSRI的使用（r = 0.09，p ≤ 0.0001）相关：结论：在服用 NVKA 的同时服用抗血小板药物、糖皮质激素和 SSRIs 会增加任何出血和消化道出血的风险。

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引用次数: 0

Safety and Usefulness of Intracoronary Acetylcholine 200 μg Into the Left Coronary Artery as Vasoreactivity Testing: Comparisons With Intracoronary Acetylcholine Maximum 100 μg 冠状动脉内乙酰胆碱 200 μg 进入左冠状动脉作为血管活性测试的安全性和实用性：与冠状动脉内乙酰胆碱最大值 100 μg 的比较。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-02 DOI: 10.1002/clc.70001

Shozo Sueda, Yutaka Hayashi, Hiroki Ono, Tomoki Sakaue, Shuntaro Ikeda

Objectives

We retrospectively analyzed the usefulness and safety of intracoronary acetylcholine (ACh) 200 μg into the left coronary artery (LCA) as vasoreactivity testing compared with intracoronary ACh 100 μg.

Methods

We recruited 1433 patients who had angina-like chest pain and intracoronary ACh testing in the LCA, including 1234 patients with a maximum ACh 100 μg and 199 patients with a maximum ACh 200 μg. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis, usual chest pain, and ischemic electrocardiogram (ECG) changes.

Results

The incidence of coronary constriction ≥ 90%, usual chest pain, and ischemic ECG changes with a maximum ACh of 100 μg was markedly higher than that with a maximum ACh of 200 μg. The frequency of unusual chest pain in patients with a maximum ACh of 200 μg was higher than that in those with a maximum ACh of 100 μg (13% vs. 3%, p < 0.001). In patients with rest angina, positive spasm of maximum ACh 100 μg was significantly higher than that of maximum ACh 200 μg, whereas there was no difference regarding positive spasm in patients with atypical chest pain between the two ACh doses. Major complications (1.38% vs. 1.51%, p = 0.8565) and the occurrence of paroxysmal atrial fibrillation (1.81% vs. 2.63%, p = 0.6307) during ACh testing in the LCA were not different between the two maximum ACH doses.

Conclusions

Intracoronary ACh 200 μg into the LCA is clinically useful and safe for vasoreactivity testing when intracoronary ACh 100 μg dose not provoke spasms.

目的：我们回顾性分析了左冠状动脉（LCA）冠状动脉内乙酰胆碱（ACh）200 μg与冠状动脉内ACh 100 μg作为血管活性测试的有用性和安全性：我们招募了 1433 名有心绞痛样胸痛并在 LCA 进行冠脉内 ACh 测试的患者，其中 1234 名患者的 ACh 最大值为 100 μg，199 名患者的 ACh 最大值为 200 μg。ACh 以 20/50/100/200 μg 的递增剂量注入 LCA。狭窄≥90%、常见胸痛和缺血性心电图（ECG）改变即为阳性痉挛：最大 ACh 值为 100 μg 时，冠状动脉收缩≥90%、常见胸痛和缺血性心电图变化的发生率明显高于最大 ACh 值为 200 μg 时。最大 ACh 值为 200 μg 的患者出现异常胸痛的频率高于最大 ACh 值为 100 μg 的患者（13% 对 3%，P，结论）：当冠状动脉内 ACh 100 μg 剂量不会引起痉挛时，冠状动脉内 ACh 200 μg 进入 LCA 对血管活性测试具有临床实用性和安全性。

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引用次数: 0

Pulsed-Field Ablation in Management of Ventricular Tachycardia: A Systematic Review of Case Reports and Clinical Outcomes 脉冲场消融治疗室性心动过速：病例报告和临床结果的系统回顾。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-10-01 DOI: 10.1002/clc.70018

Amir Askarinejad, Erfan Kohansal, Amirreza Sabahizadeh, Hamed Hesami, Sara Adimi, Majid Haghjoo

Background

Pulsed-field ablation (PFA) is a cutting-edge technique that employs non-thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo-ablation for treating ventricular tachycardia.

Methods

PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed-field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis.

Results

We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long-term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases.

Conclusion

The absence of complications, high effectiveness, and long-term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed.

背景：脉冲场消融术（PFA）是一种尖端技术，它利用非热能量通过诱导细胞膜的不可逆电穿孔而导致细胞死亡。本系统综述评估了射频场消融作为射频和冷冻消融治疗室性心动过速的潜在替代方法的有效性：使用与室速和脉冲场消融相关的关键词对 PubMed、Embase、Scopus 和 Web of Science 进行了系统检索。最终分析纳入了评估这种室性心动过速治疗方法的合格研究：我们在系统回顾中纳入了六项研究（五项病例报告和一项系列病例）。其中八项（88.8%）手术成功，长期疗效达 100%。这些病例均未出现手术并发症或室性心动过速（VT）复发：结论：PFA 无并发症、疗效高、长期成功率高，是治疗 VT 的良好选择。然而，PFA 治疗 VT 的安全性和有效性研究还很少。因此，迫切需要对这一课题进行更大规模的研究。

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引用次数: 0

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