Clinical Cardiology最新文献_第8页

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

Sex-Specific Differences in Cardiovascular Adaptations and Risks in Elite Athletes: Bridging the Gap in Sports Cardiology 精英运动员心血管适应性和风险的性别差异：缩小运动心脏病学的差距。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-04 DOI: 10.1002/clc.70006

Siamak Afaghi, Fatemeh Sadat Rahimi, Pegah Soltani, Arda Kiani, Atefeh Abedini

Background

The growing participation of women in competitive sports necessitates a comprehensive understanding of sex-specific cardiovascular adaptations and risks. Historically, research has predominantly focused on male athletes, leaving a gap in knowledge about the unique cardiovascular dynamics of female peers.

Hypothesis

we hypothesized that female athletes exhibit distinct cardiovascular adaptations and face different risks, influenced by physiological, hormonal, and structural differences.

Methods

A systematic review of the literature was conducted, analyzing studies on cardiovascular responses and adaptations in athletes. Data were extracted on hemodynamic changes, autonomic and neural reflex regulation, cardiac remodeling, and arrhythmias. Comparative analyses were performed to identify sex-specific patterns and discrepancies in cardiovascular health outcomes.

Results

We revealed considerable sex differences in cardiovascular adaptations to athletic training. Female athletes generally have longer QT intervals, greater sinoatrial node automaticity, and enhanced atrioventricular node function compared to males. They also exhibit lower sympathetic activity, lower maximal stroke volumes, and a tendency toward eccentric cardiac remodeling. Conversely, male athletes are more prone to concentric hypertrophy and higher incidences of bradyarrhythmia and accessory pathway arrhythmias. Female athletes are more likely to experience symptomatic atrial fibrillation and face higher procedural complications during catheter ablation.

Conclusions

Our findings underscore the necessity for sex-specific approaches in sports cardiology. Recognizing and addressing these differences could enhance performance and reduce adverse cardiac events in athletes. Future research should focus on developing tailored screening, prevention, and treatment strategies to bridge the knowledge gap and promote cardiovascular health in both male and female athletes.

背景：随着越来越多的女性参与竞技体育，我们有必要全面了解女性特有的心血管适应性和风险。假设：我们假设，受生理、荷尔蒙和结构差异的影响，女性运动员表现出独特的心血管适应性并面临不同的风险：方法：我们对文献进行了系统回顾，分析了有关运动员心血管反应和适应性的研究。提取了有关血液动力学变化、自律神经反射调节、心脏重塑和心律失常的数据。我们进行了比较分析，以确定心血管健康结果的性别特异性模式和差异：结果：我们发现，在心血管对运动训练的适应性方面，性别差异相当大。与男性相比，女性运动员的 QT 间期通常更长，中房结的自动性更高，房室结功能更强。她们还表现出较低的交感神经活动、较低的最大每搏量以及偏心性心脏重塑的倾向。相反，男性运动员更容易出现同心性肥大，缓性心律失常和附属通路心律失常的发生率更高。女性运动员更容易出现有症状的心房颤动，在导管消融过程中面临更高的手术并发症：我们的研究结果表明，有必要在运动心脏病学中采用针对不同性别的方法。认识并解决这些差异可以提高运动员的成绩，减少不良心脏事件的发生。未来的研究应侧重于制定有针对性的筛查、预防和治疗策略，以弥补知识差距，促进男女运动员的心血管健康。

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引用次数: 0

Impact of Donor−Recipient BMI Ratio on Survival Outcomes of Heart Transplant Recipients: A Retrospective Analysis Study 供体-受体体重指数比对心脏移植受体生存结果的影响：回顾性分析研究

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-09-04 DOI: 10.1002/clc.70010

Yucheng Zhong, Changdong Zhang, Yixuan Wang, Mei Liu, Xiaoke Shang, Nianguo Dong

Objective

This study aimed to investigate the impact of the donor−recipient BMI ratio on the survival outcomes of heart transplant recipients.

Methods

A retrospective analysis was conducted on 641 heart transplant patients who underwent surgery between September 2008 and June 2021. The BMI ratio (donor BMI divided by recipient BMI) was calculated for each patient. Kaplan−Meier survival analysis and Cox proportional hazards regression were performed to evaluate survival rates and determine the hazard ratio (HR) for mortality.

Results

Significant differences were found in donor age and donor−recipient height ratio between the BMI ratio groups. The BMI ratio ≥ 1 group had a higher mean donor age (37.27 ± 10.54 years) compared to the BMI ratio < 1 group (34.72 ± 11.82 years, p = 0.008), and a slightly higher mean donor−recipient height ratio (1.02 ± 0.06 vs. 1.00 ± 0.05, p = 0.002). The Kaplan−Meier survival analysis indicated that the survival rate in the BMI ratio ≥ 1 group was significantly lower than in the BMI ratio < 1 group. Cox multivariate analysis, adjusted for confounding factors, revealed a HR of 1.50 (95% CI: 1.08−2.09) for mortality in patients with a BMI ratio ≥ 1. No significant differences were observed in ICU stay, postoperative hospitalization days, or total mechanical ventilation time between the groups.

Conclusion

A higher donor−recipient BMI ratio was associated with an increased risk of mortality in heart transplant recipients.

研究目的本研究旨在探讨供体与受体体重指数比值对心脏移植受体生存结果的影响：方法：对 2008 年 9 月至 2021 年 6 月期间接受手术的 641 名心脏移植患者进行了回顾性分析。计算了每位患者的体重指数比（供体体重指数除以受体体重指数）。采用 Kaplan-Meier 生存分析和 Cox 比例危险回归评估生存率，并确定死亡率的危险比 (HR)：结果：BMI 比值组之间的供体年龄和供体-受体身高比存在显著差异。与 BMI 比率结论组相比，BMI 比率≥1 组的平均供体年龄更高（37.27 ± 10.54 岁）：供体-受体 BMI 比率越高，心脏移植受体的死亡风险越高。

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引用次数: 0

Characteristics of Patients With Atherosclerotic Cardiovascular Disease in Belgium and Current Treatment Patterns for the Management of Elevated LDL-C Levels 比利时动脉粥样硬化性心血管疾病患者的特征和目前治疗低密度脂蛋白胆固醇水平升高的模式

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-08-29 DOI: 10.1002/clc.24330

Eléonore Maury, Samuel Brouyère, Mieke Jansen

Background

Dyslipidemia remains the major cause of atherosclerotic cardiovascular disease (ASCVD). Lipid management in patients with increased cardiovascular (CV) risk needs improvement across Europe, and data gaps are noticeable at the country level.

Hypothesis

We described the current treatment landscape in Belgium, hypothesizing that lipid management in patients with ASCVD remains inadequate and aiming to understand the reasons.

Methods

Using data from an anonymized primary care database in Belgium derived from 494 750 individuals, we identified those with any CV risk factor between November 2019 and October 2022 and described the clinical features of patients with ASCVD. The main outcomes were the proportion of patients (i) receiving lipid-lowering therapies (LLTs), (ii) per low-density lipoprotein cholesterol (LDL-C) threshold, stratified per LLT, (iii) reaching the 2021 ESC recommended LDL-C goals, and (iv) LDL-C reduction per type of LLT was also determined.

Results

Among 40 888 patients with very high CV risk, 24 859 had established ASCVD. Most patients with ASCVD were either receiving monotherapy (59.6%) or had no documented LLT (25.1%). Further, 64.2% of those with no documented LLT exhibited LDL-C levels ≥ 100 mg/dL. Among common treatment options, one of the greatest improvements in LDL-C levels was achieved with combination therapy of statin and ezetimibe, reducing LDL-C levels by 41.5% (p < 0.0001). Yet, in this group, 24.8% of patients had still LDL-C levels ≥ 100 mg/dL and only 20.7% were at goal.

Conclusion

Our study emphasizes the importance of developing strategies to help patients achieve their LDL-C goals, with a focus on supporting the implementation of combination LLT in routine clinical practice.

背景血脂异常仍然是动脉粥样硬化性心血管疾病（ASCVD）的主要病因。整个欧洲都需要改善对心血管疾病（CV）风险增加患者的血脂管理，而国家层面的数据缺口非常明显。假设我们描述了比利时目前的治疗情况，假设 ASCVD 患者的血脂管理仍然不足，并希望了解其中的原因。方法我们利用比利时匿名初级保健数据库中来自 494 750 人的数据，确定了 2019 年 11 月至 2022 年 10 月期间存在任何心血管疾病风险因素的患者，并描述了 ASCVD 患者的临床特征。主要结果是：(i) 接受降脂疗法（LLTs）的患者比例；(ii) 按低密度脂蛋白胆固醇（LDL-C）阈值分层的患者比例；(iii) 达到 2021 年 ESC 推荐的 LDL-C 目标的患者比例；(iv) 按 LLT 类型降低 LDL-C 的患者比例。结果在 40 888 名具有极高 CV 风险的患者中，有 24 859 人已确诊为 ASCVD。大多数 ASCVD 患者要么接受单一疗法（59.6%），要么没有 LLT 记录（25.1%）。此外，在没有低密度脂蛋白胆固醇治疗记录的患者中，64.2%的患者低密度脂蛋白胆固醇水平≥100 mg/dL。在常见的治疗方案中，他汀类药物和依折麦布联合治疗对 LDL-C 水平的改善最大，LDL-C 水平降低了 41.5%（p < 0.0001）。然而，在这组患者中，仍有 24.8% 的患者 LDL-C 水平≥ 100 mg/dL，只有 20.7% 的患者达到目标。结论我们的研究强调了制定策略帮助患者实现低密度脂蛋白胆固醇目标的重要性，重点是支持在常规临床实践中实施联合 LLT。

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引用次数: 0

Clopidogrel Versus Aspirin as Monotherapy Following Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Receiving a Drug-Eluting Stent: A Systematic Literature Review and Meta-Analysis 接受药物洗脱支架治疗的急性冠状动脉综合征患者在接受双联抗血小板疗法后单用氯吡格雷与阿司匹林：系统性文献综述和元分析

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-08-29 DOI: 10.1002/clc.24326

Dirk Sibbing, Johny Nicolas, Alessandro Spirito, Birgit Vogel, Davide Cao, Wanda Stipek, Ellen Kasireddy, Andi Qian, Irfan Khan, Roxana Mehran

Objective

This study aimed to evaluate the comparative effectiveness and safety of clopidogrel versus aspirin as monotherapy following adequate dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS).

Methods

MEDLINE, Embase, and CENTRAL were searched from database inception to September 1, 2023. Randomized controlled trials (RCTs) and observational studies evaluating the effectiveness or safety of clopidogrel versus aspirin as monotherapy following DAPT in patients with ACS who received a drug-eluting stent were included. Random-effects meta-analyses were conducted to compare risks of major adverse cardiovascular events (MACE) and clinically relevant bleeding.

Results

Of 6242 abstracts identified, three unique studies were included: one RCT and two retrospective cohort studies. Studies included a total of 7081 post-percutaneous coronary intervention ACS patients, 4260 of whom received aspirin monotherapy and 2821 received clopidogrel monotherapy. Studies included variable proportions of patients with ST-elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. From the meta-analysis, clopidogrel was associated with a 28% reduction in the risk of MACE compared with aspirin (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), with no significant difference in clinically relevant bleeding (HR: 0.92; 95% CI: 0.68, 1.24).

Conclusion

Despite the paucity of published evidence on the effectiveness and safety of clopidogrel versus aspirin in patients with ACS post-drug-eluting stent implantation, this meta-analysis suggests that clopidogrel versus aspirin may result in a lower risk of MACE, with a similar risk of major bleeding. The present results are hypothesis-generating and further large RCTs comparing antiplatelet monotherapy options in ACS patients are warranted.

目的本研究旨在评估在急性冠状动脉综合征（ACS）患者接受充分的双联抗血小板疗法（DAPT）后，氯吡格雷单药治疗与阿司匹林单药治疗的有效性和安全性比较。方法检索从数据库开始到 2023 年 9 月 1 日的 MEDLINE、Embase 和 CENTRAL。纳入了对接受药物洗脱支架治疗的 ACS 患者在 DAPT 后单药治疗氯吡格雷与阿司匹林的有效性或安全性进行评估的随机对照试验 (RCT) 和观察性研究。进行了随机效应荟萃分析，以比较主要不良心血管事件（MACE）和临床相关出血的风险。结果在确定的 6242 篇摘要中，纳入了三项独特的研究：一项 RCT 和两项回顾性队列研究。研究共纳入 7081 例经皮冠状动脉介入治疗后 ACS 患者，其中 4260 例接受阿司匹林单药治疗，2821 例接受氯吡格雷单药治疗。研究纳入了不同比例的ST段抬高型心肌梗死（STEMI）、非STEMI和不稳定型心绞痛患者。荟萃分析结果表明，与阿司匹林相比，氯吡格雷可将MACE风险降低28%（危险比[HR]：0.72；95%置信区间[CI]：0.54, 0.98），而临床相关出血方面无显著差异（HR：0.92；95% CI：0.68, 1.24）。结论尽管有关药物洗脱支架植入术后 ACS 患者使用氯吡格雷与阿司匹林的有效性和安全性的已发表证据很少，但这项荟萃分析表明，氯吡格雷与阿司匹林相比，MACE 风险较低，大出血风险相似。本研究结果具有假设性，有必要进一步开展大型 RCT 研究，比较 ACS 患者的抗血小板单药治疗方案。

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引用次数: 0

Lack of Class I Vasoreactivity Testing for Diagnosing Patients With Coronary Artery Spasm 缺乏用于诊断冠状动脉痉挛患者的 I 级血管活性测试。

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology

Pub Date : 2024-08-28 DOI: 10.1002/clc.70004

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

Background

Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS).

Hypothesis

Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm.

Methods

Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I.

Results

There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent.

Conclusions

Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA.

背景：根据冠状动脉血管运动障碍国际研究（COVADIS）小组的建议和日本循环学会（JCS）的指南，血管活性测试，如冠状动脉内乙酰胆碱（ACh）或麦角新碱（EM），被定义为诊断血管痉挛性心绞痛（VSA）患者的I级测试：假设：虽然血管反应性测试是一种临床有用的工具，但它在诊断冠状动脉痉挛方面存在一定的风险和局限性：方法：从 I 级的角度总结了以往关于血管反应性测试诊断冠状动脉痉挛的报告：结果：与日常痉挛相关的几个问题，如可重复性、低估、高估和不确定/非特异性结果。由于冠状动脉内 ACh 引起的激惹性痉挛与冠状动脉内 EM 引起的激惹性痉挛并不总是相似的，这可能是由于介质不同所致，因此，当每种血管活性剂都不能显示出激惹性痉挛时，心脏病专家有必要辅助使用这些血管活性测试来诊断 VSA：结论：心脏病专家在诊断 VSA 患者时应了解这些血管活性测试的不完善之处。

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引用次数: 0