Pub Date : 2024-09-29DOI: 10.1093/eurheartj/ehae462
Jeehoon Kang, Junpil Yun, Kyung Woo Park, Minae Park, Sojeong Park, Doyeon Hwang, Jung-Kyu Han, Han-Mo Yang, Hyun-Jae Kang, Bon-Kwon Koo, Dominick J Angiolillo, Philip Urban, Hyo-Soo Kim
Background and aims: Patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) are at increased risk of not only bleeding, but also ischaemic events. This study aimed to determine the long-term relative risk of ischaemic and bleeding events in HBR patients.
Methods: This study was a nationwide cohort study, based on the Korean National Health Insurance Review and Assessment Service database. Patients diagnosed with stable angina or acute coronary syndrome and those who underwent PCI in Korea between 2009 and 2018 were included in the analysis. According to the Academic Research Consortium HBR criteria, the total population was divided into HBR and non-HBR groups. The co-primary outcomes were major bleeding events and ischaemic (composite of cardiac death, myocardial infarction, and ischaemic stroke) events.
Results: Among a total of 325 417 patients who underwent PCI, 66 426 patients (20.4%) had HBR. During the follow-up period, HBR patients had a higher risk for major bleeding events (23.9% vs. 8.9%, P < .001) and ischaemic events (33.8% vs. 14.4%, P < .001). However, the impact of HBR was significant for major bleeding events [hazard ratio (HR) 3.12, 95% confidence interval (CI) 3.04-3.21, P < .001] and for ischaemic events (HR 2.50, 95% CI 2.45-2.56, P < .001). The HBR group was also associated with a greater risk of all-cause mortality (HR 3.73, 95% CI 3.66-3.79, P < .001). The average annual rate of major bleeding events within the first year after PCI was 5.5% for a single major criterion, and 2.9% for a single minor criterion.
Conclusions: Among patients undergoing PCI, those with HBR were at increased long-term risk for both bleeding and ischaemic events, with a greater risk of mortality compared to non-HBR patients.
{"title":"Long-term outcomes of high bleeding risk patients undergoing percutaneous coronary intervention: a Korean nationwide registry.","authors":"Jeehoon Kang, Junpil Yun, Kyung Woo Park, Minae Park, Sojeong Park, Doyeon Hwang, Jung-Kyu Han, Han-Mo Yang, Hyun-Jae Kang, Bon-Kwon Koo, Dominick J Angiolillo, Philip Urban, Hyo-Soo Kim","doi":"10.1093/eurheartj/ehae462","DOIUrl":"10.1093/eurheartj/ehae462","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) are at increased risk of not only bleeding, but also ischaemic events. This study aimed to determine the long-term relative risk of ischaemic and bleeding events in HBR patients.</p><p><strong>Methods: </strong>This study was a nationwide cohort study, based on the Korean National Health Insurance Review and Assessment Service database. Patients diagnosed with stable angina or acute coronary syndrome and those who underwent PCI in Korea between 2009 and 2018 were included in the analysis. According to the Academic Research Consortium HBR criteria, the total population was divided into HBR and non-HBR groups. The co-primary outcomes were major bleeding events and ischaemic (composite of cardiac death, myocardial infarction, and ischaemic stroke) events.</p><p><strong>Results: </strong>Among a total of 325 417 patients who underwent PCI, 66 426 patients (20.4%) had HBR. During the follow-up period, HBR patients had a higher risk for major bleeding events (23.9% vs. 8.9%, P < .001) and ischaemic events (33.8% vs. 14.4%, P < .001). However, the impact of HBR was significant for major bleeding events [hazard ratio (HR) 3.12, 95% confidence interval (CI) 3.04-3.21, P < .001] and for ischaemic events (HR 2.50, 95% CI 2.45-2.56, P < .001). The HBR group was also associated with a greater risk of all-cause mortality (HR 3.73, 95% CI 3.66-3.79, P < .001). The average annual rate of major bleeding events within the first year after PCI was 5.5% for a single major criterion, and 2.9% for a single minor criterion.</p><p><strong>Conclusions: </strong>Among patients undergoing PCI, those with HBR were at increased long-term risk for both bleeding and ischaemic events, with a greater risk of mortality compared to non-HBR patients.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":37.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1093/eurheartj/ehae177
Christiaan Vrints, Felicita Andreotti, Konstantinos C Koskinas, Xavier Rossello, Marianna Adamo, James Ainslie, Adrian Paul Banning, Andrzej Budaj, Ronny R Buechel, Giovanni Alfonso Chiariello, Alaide Chieffo, Ruxandra Maria Christodorescu, Christi Deaton, Torsten Doenst, Hywel W Jones, Vijay Kunadian, Julinda Mehilli, Milan Milojevic, Jan J Piek, Francesca Pugliese, Andrea Rubboli, Anne Grete Semb, Roxy Senior, Jurrien M Ten Berg, Eric Van Belle, Emeline M Van Craenenbroeck, Rafael Vidal-Perez, Simon Winther
{"title":"2024 ESC Guidelines for the management of chronic coronary syndromes.","authors":"Christiaan Vrints, Felicita Andreotti, Konstantinos C Koskinas, Xavier Rossello, Marianna Adamo, James Ainslie, Adrian Paul Banning, Andrzej Budaj, Ronny R Buechel, Giovanni Alfonso Chiariello, Alaide Chieffo, Ruxandra Maria Christodorescu, Christi Deaton, Torsten Doenst, Hywel W Jones, Vijay Kunadian, Julinda Mehilli, Milan Milojevic, Jan J Piek, Francesca Pugliese, Andrea Rubboli, Anne Grete Semb, Roxy Senior, Jurrien M Ten Berg, Eric Van Belle, Emeline M Van Craenenbroeck, Rafael Vidal-Perez, Simon Winther","doi":"10.1093/eurheartj/ehae177","DOIUrl":"10.1093/eurheartj/ehae177","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":37.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1093/eurheartj/ehae179
Lucia Mazzolai, Gisela Teixido-Tura, Stefano Lanzi, Vinko Boc, Eduardo Bossone, Marianne Brodmann, Alessandra Bura-Rivière, Julie De Backer, Sebastien Deglise, Alessandro Della Corte, Christian Heiss, Marta Kałużna-Oleksy, Donata Kurpas, Carmel M McEniery, Tristan Mirault, Agnes A Pasquet, Alex Pitcher, Hannah A I Schaubroeck, Oliver Schlager, Per Anton Sirnes, Muriel G Sprynger, Eugenio Stabile, Françoise Steinbach, Matthias Thielmann, Roland R J van Kimmenade, Maarit Venermo, Jose F Rodriguez-Palomares
{"title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases.","authors":"Lucia Mazzolai, Gisela Teixido-Tura, Stefano Lanzi, Vinko Boc, Eduardo Bossone, Marianne Brodmann, Alessandra Bura-Rivière, Julie De Backer, Sebastien Deglise, Alessandro Della Corte, Christian Heiss, Marta Kałużna-Oleksy, Donata Kurpas, Carmel M McEniery, Tristan Mirault, Agnes A Pasquet, Alex Pitcher, Hannah A I Schaubroeck, Oliver Schlager, Per Anton Sirnes, Muriel G Sprynger, Eugenio Stabile, Françoise Steinbach, Matthias Thielmann, Roland R J van Kimmenade, Maarit Venermo, Jose F Rodriguez-Palomares","doi":"10.1093/eurheartj/ehae179","DOIUrl":"10.1093/eurheartj/ehae179","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":37.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1093/eurheartj/ehae572
Nona Sargisian, Max Petzold, Eva Furenäs, Mika Gissler, Anne Lærke Spangmose, Sara Malchau Lauesgaard, Signe Opdahl, Anja Pinborg, Anna-Karina A Henningsen, Kjersti Westvik-Johari, Kristiina Rönö, Christina Bergh, Ulla-Britt Wennerholm
Background and Aims Children born after assisted reproductive technology (ART) have worse perinatal outcomes compared with spontaneously conceived children. This study investigates whether children conceived after ART have a higher risk of congenital heart defects (CHDs) compared with children born after spontaneous conception (SC). Methods All 7 747 637 liveborn children in Denmark (1994–2014), Finland (1990–2014), Norway (1984–2015), and Sweden (1987–2015), where 171 735 children were conceived after ART, were included. National ART and medical birth registry data were cross-linked with data from other health and population registries. Outcomes were major CHDs, severe CHDs, 6 hierarchical CHD lesion groups, and 10 selected major CHDs, diagnosed prenatally or up to 1 year of age (Denmark, Finland, and Sweden) and prenatally or at birth (Norway). The association between ART and CHDs was assessed with multivariable logistic regression analysis, with adjustment for available confounders. Results Major CHDs were detected in 3159 children born after ART (1.84%) and in 86 824 children born after SC [1.15%; adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 1.31–1.41]. Risk was highest in multiples, regardless of conception method. Severe CHDs were detected in 594 children born after ART (0.35%) and in 19 375 children born after SC (0.26%; AOR 1.30; 95% CI 1.20–1.42). Risk was similar between ICSI and IVF and between frozen and fresh embryo transfer. Conclusions Assisted reproductive technology–conceived children have a higher prevalence of major CHDs, being rare, but severe conditions. The absolute risks are, however, modest and partly associated with multiple pregnancies, more prevalent in ART.
{"title":"Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study","authors":"Nona Sargisian, Max Petzold, Eva Furenäs, Mika Gissler, Anne Lærke Spangmose, Sara Malchau Lauesgaard, Signe Opdahl, Anja Pinborg, Anna-Karina A Henningsen, Kjersti Westvik-Johari, Kristiina Rönö, Christina Bergh, Ulla-Britt Wennerholm","doi":"10.1093/eurheartj/ehae572","DOIUrl":"https://doi.org/10.1093/eurheartj/ehae572","url":null,"abstract":"Background and Aims Children born after assisted reproductive technology (ART) have worse perinatal outcomes compared with spontaneously conceived children. This study investigates whether children conceived after ART have a higher risk of congenital heart defects (CHDs) compared with children born after spontaneous conception (SC). Methods All 7 747 637 liveborn children in Denmark (1994–2014), Finland (1990–2014), Norway (1984–2015), and Sweden (1987–2015), where 171 735 children were conceived after ART, were included. National ART and medical birth registry data were cross-linked with data from other health and population registries. Outcomes were major CHDs, severe CHDs, 6 hierarchical CHD lesion groups, and 10 selected major CHDs, diagnosed prenatally or up to 1 year of age (Denmark, Finland, and Sweden) and prenatally or at birth (Norway). The association between ART and CHDs was assessed with multivariable logistic regression analysis, with adjustment for available confounders. Results Major CHDs were detected in 3159 children born after ART (1.84%) and in 86 824 children born after SC [1.15%; adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 1.31–1.41]. Risk was highest in multiples, regardless of conception method. Severe CHDs were detected in 594 children born after ART (0.35%) and in 19 375 children born after SC (0.26%; AOR 1.30; 95% CI 1.20–1.42). Risk was similar between ICSI and IVF and between frozen and fresh embryo transfer. Conclusions Assisted reproductive technology–conceived children have a higher prevalence of major CHDs, being rare, but severe conditions. The absolute risks are, however, modest and partly associated with multiple pregnancies, more prevalent in ART.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":39.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1093/eurheartj/ehae618
Andrea Natale, Sanghamitra Mohanty, Prashanthan Sanders, Elad Anter, Ashok Shah, Ghaliah Al Mohani, Michael Haissaguerre
Recent advances in techniques, technologies and proven superiority over anti-arrhythmic drugs have made catheter ablation the cornerstone of management for atrial fibrillation (AF), which has shown a steady increase in prevalence in the ageing population worldwide. The aim of therapeutic interventions is to achieve stable sinus rhythm that would improve the quality of life and reduce the risk of AF-associated complications. Pulmonary veins (PVs) were first described as the source of initiation of ectopic triggers driving AF, which led to the establishment of PV isolation (PVI) as the most widely practiced procedure to treat AF. Antral PVI is still recognized as the stand-alone ablation strategy for newly diagnosed paroxysmal AF (PAF). However, in non-PAF patients, PVI seems to be inadequate and several adjunctive strategies, including ablation of left atrial posterior wall and non-PV triggers, AF mapping and ablation of rotors and drivers, ethanol infusion of vein of Marshall and renal denervation, etc. have been reported with mixed results. Recent trials have also documented the benefits of early rhythm control in preventing cardiovascular events in addition to slowing the progression of PAF to more persistent forms. Similarly, very late relapse of the arrhythmia after successful PVI has drawn attention to the critical role of non-PV triggers and highlighted their relevance as potential ablation targets during repeat procedures. Ablation technology is also under constant evolution with the introduction of non-thermal energy sources and new tools to create durable lesions. This review summarizes the indications, advancements, and future perspective of AF ablation.
{"title":"Catheter ablation for atrial fibrillation: indications and future perspective","authors":"Andrea Natale, Sanghamitra Mohanty, Prashanthan Sanders, Elad Anter, Ashok Shah, Ghaliah Al Mohani, Michael Haissaguerre","doi":"10.1093/eurheartj/ehae618","DOIUrl":"https://doi.org/10.1093/eurheartj/ehae618","url":null,"abstract":"Recent advances in techniques, technologies and proven superiority over anti-arrhythmic drugs have made catheter ablation the cornerstone of management for atrial fibrillation (AF), which has shown a steady increase in prevalence in the ageing population worldwide. The aim of therapeutic interventions is to achieve stable sinus rhythm that would improve the quality of life and reduce the risk of AF-associated complications. Pulmonary veins (PVs) were first described as the source of initiation of ectopic triggers driving AF, which led to the establishment of PV isolation (PVI) as the most widely practiced procedure to treat AF. Antral PVI is still recognized as the stand-alone ablation strategy for newly diagnosed paroxysmal AF (PAF). However, in non-PAF patients, PVI seems to be inadequate and several adjunctive strategies, including ablation of left atrial posterior wall and non-PV triggers, AF mapping and ablation of rotors and drivers, ethanol infusion of vein of Marshall and renal denervation, etc. have been reported with mixed results. Recent trials have also documented the benefits of early rhythm control in preventing cardiovascular events in addition to slowing the progression of PAF to more persistent forms. Similarly, very late relapse of the arrhythmia after successful PVI has drawn attention to the critical role of non-PV triggers and highlighted their relevance as potential ablation targets during repeat procedures. Ablation technology is also under constant evolution with the introduction of non-thermal energy sources and new tools to create durable lesions. This review summarizes the indications, advancements, and future perspective of AF ablation.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":39.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1093/eurheartj/ehae619
Phyllis M Thangaraj, Sean H Benson, Evangelos K Oikonomou, Folkert W Asselbergs, Rohan Khera
Digital twins, which are in silico replications of an individual and its environment, have advanced clinical decision-making and prognostication in cardiovascular medicine. The technology enables personalized simulations of clinical scenarios, prediction of disease risk, and strategies for clinical trial augmentation. Current applications of cardiovascular digital twins have integrated multi-modal data into mechanistic and statistical models to build physiologically accurate cardiac replicas to enhance disease phenotyping, enrich diagnostic workflows, and optimize procedural planning. Digital twin technology is rapidly evolving in the setting of newly available data modalities and advances in generative artificial intelligence, enabling dynamic and comprehensive simulations unique to an individual. These twins fuse physiologic, environmental, and healthcare data into machine learning and generative models to build real-time patient predictions that can model interactions with the clinical environment to accelerate personalized patient care. This review summarizes digital twins in cardiovascular medicine and their potential future applications by incorporating new personalized data modalities. It examines the technical advances in deep learning and generative artificial intelligence that broaden the scope and predictive power of digital twins. Finally, it highlights the individual and societal challenges as well as ethical considerations that are essential to realizing the future vision of incorporating cardiology digital twins into personalized cardiovascular care.
{"title":"Cardiovascular care with digital twin technology in the era of generative artificial intelligence","authors":"Phyllis M Thangaraj, Sean H Benson, Evangelos K Oikonomou, Folkert W Asselbergs, Rohan Khera","doi":"10.1093/eurheartj/ehae619","DOIUrl":"https://doi.org/10.1093/eurheartj/ehae619","url":null,"abstract":"Digital twins, which are in silico replications of an individual and its environment, have advanced clinical decision-making and prognostication in cardiovascular medicine. The technology enables personalized simulations of clinical scenarios, prediction of disease risk, and strategies for clinical trial augmentation. Current applications of cardiovascular digital twins have integrated multi-modal data into mechanistic and statistical models to build physiologically accurate cardiac replicas to enhance disease phenotyping, enrich diagnostic workflows, and optimize procedural planning. Digital twin technology is rapidly evolving in the setting of newly available data modalities and advances in generative artificial intelligence, enabling dynamic and comprehensive simulations unique to an individual. These twins fuse physiologic, environmental, and healthcare data into machine learning and generative models to build real-time patient predictions that can model interactions with the clinical environment to accelerate personalized patient care. This review summarizes digital twins in cardiovascular medicine and their potential future applications by incorporating new personalized data modalities. It examines the technical advances in deep learning and generative artificial intelligence that broaden the scope and predictive power of digital twins. Finally, it highlights the individual and societal challenges as well as ethical considerations that are essential to realizing the future vision of incorporating cardiology digital twins into personalized cardiovascular care.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":39.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1093/eurheartj/ehae663
Carlos Aguiar,Paulus Kirchhof,Franz Weidinger
{"title":"Updated declaration of interests for European Society of Cardiology volunteers and officers.","authors":"Carlos Aguiar,Paulus Kirchhof,Franz Weidinger","doi":"10.1093/eurheartj/ehae663","DOIUrl":"https://doi.org/10.1093/eurheartj/ehae663","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":null,"pages":null},"PeriodicalIF":39.3,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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