Expert Review of Cardiovascular Therapy最新文献

Introduction: Cangrelor is the only parenteral P2Y₁₂ receptor antagonist currently recommended for the prevention of periprocedural thrombotic complications in P2Y₁₂ inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI).

Areas covered: This review provides a comprehensive analysis of the pharmacological properties and administration strategies of cangrelor in PCI, summarizes the latest evidence from clinical trials and real-world studies, and discusses potential future directions for its application in clinical practice. Literature search was conducted using PubMed up to May 2025.

Expert opinion: Cangrelor provides rapid platelet inhibition following an intravenous bolus, and its short half-life ensures predictable pharmacokinetic profile, facilitating perioperative management. The CHAMPION program demonstrated that cangrelor significantly reduces early ischemic events, including myocardial infarction and stent thrombosis, compared with clopidogrel in patients undergoing PCI. Since its approval, several clinical trials and observational studies have further evaluated the efficacy and safety of cangrelor and its optimal use. The adoption of cangrelor in catheterization laboratories worldwide remains inconsistent, with misuse being frequently reported. Drug-related costs along with concerns surrounding drug interaction when switching to oral P2Y₁₂ inhibitors, limited safety data in high-risk populations and lack of evidence on the comparison against ticagrelor or prasugrel may contribute to its restricted utilization in clinical practice.

Introduction: Ebstein anomaly (EA) is a rare congenital heart defect with a broad spectrum of severity - both anatomically and clinically. Treatment options have evolved and hence the rationale for this review.

Areas covered: This manuscript reviews all of the current literature including the recent expert consensus document that describes the updated diagnostic and treatment strategies. A citation search in PubMed, Embase, Scopus, and Web of Science was performed using key words related to EA. The search was restricted to the English language and the years 1990 to present.

Expert opinion: The expert commentary is a summary of the 2 most recent expert consensus documents and also pros and fit pitfalls based on the authors institutional experience which is the largest in the world.

Background: Compliance of prescriptions with treatment guidelines (CPTG) after an acute coronary syndrome (ACS) is poorly studied. We studied CPTG index levels in ERICO cohort over three years and its association with long-term mortality.

Research design and methods: We analyzed data from 961 ERICO participants who were discharged after an ACS event. Medication information was obtained at discharge, 30 days 180 days, and yearly after the index event. The CPTG index was defined as the proportion of evidence-based medications for post-ACS care (anti-platelets, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and statins), a patient's prescription had. We verified the association between CPTG index and survival using adjusted Cox regression.

Results: The median age was 62 years, and 41% were female. At 30 days, the proportion of individuals with CPTG index = 1.0 decreased to the lowest values observed (23.4%), followed by a partial recovery (40.1% at 180 days). CPTG index was significantly associated with better survival (Hazard Ratio for a 0.1-point increase: 0.92; 95% confidence interval:0.87-0.96).

Conclusions: The CPTG index was significantly associated with long-term survival. The expressive drop in CPTG index values 30 days after discharge suggests that targeted actions might be necessary to ensure timely healthcare access in this population.

Introduction: To perform a systematic review and meta-analysis to compare the safety, early and late mortality, morbidity and long-term function of the tricuspid valve (TV) following tricuspid transcatheter edge-to-edge repair (T-TEER) compared to surgical tricuspid valve (TV) repair/replacement (TVR) for tricuspid regurgitation (TR).

Methods: This review investigates through two different databases for original studies that evaluated patients with TR who underwent either T-TEER or TVR was until December 2024. The outcomes of interest were safety, morbidity, mortality and long-term function following T-TEER vs TVR.

Results: We identified three retrospective observational studies, including a total of 1612 patients with TR. Short-term (OR, 0.36; 95% CI, 0.13-1.04; p = 0.06) and long-term mortality was similar between T-TEER and TVR. There was a lower risk of acute kidney injury (AKI) (OR, 0.31; 95% CI, 0.23-0.43; p < 0.00001) and permanent pacemaker implantation (PPI) (OR, 0.19; 95% CI, 0.10-0.35; p < 0.00001) with T-TEER, while there was no significant difference in terms of stroke events (OR, 1.17; 95% CI, 0.68-2.01; p = 0.58) and risk of bleeding (OR, 0.81; 95% CI, 0.45-1.44; p = 0.47) compared to TVR.

Conclusions: In conclusion, T-TEER appears to have a comparable safety profile to TVR with a lower risk of AKI and PPI. However, these findings are based on limited observational data and should be interpreted as hypothesis-generating rather than conclusive.

Registration: This systematic review and meta-analysis was prospectively registered on the international prospective register of systematic reviews (PROSPERO; CRD42024622555).

Introduction: Hypercholesterolemia and other dyslipidemias are common risk factors for cardiovascular diseases (CVD) and development of atherosclerosis. International guidelines recommend LDL-C, non-HDL-C and apoB under some conditions for clinical use in evaluating risk of CVD. In part 1 of this review newer risk factor data for apoA-1, and the apoB/apoA-1 ratio is presented for cardiovascular, cerebrovascular, diabetes and other CVD manifestations of atherosclerosis. Compared to conventional lipids, these apolipoproteins add strong clinical risk information for these CVD disorders and for a range of other diseases.

Areas covered: Prospective studies, reviews, meta-analyses, case control, nested-case and therapeutic studies are analyzed. Searches were conducted with Google and in PubMed, and CVD journals for peer-reviewed publications. In part 2 of this review newer risk factor data for apoA-1, and the apoB/apoA-1 ratio is presented for atherosclerotic plaques, HDL-C versus apoA-1, inflammatory diseases, cancer, and metastases.

Expert opinion: Associations between apoB, apoA-1 and especially the apoB/apoA-1 ratio and development of atherosclerosis related risk of multiple CVD diseases have been documented world-wide. This data indicates that the balance, i.e. the ratio between the atherogenic apoB and the protective apoA-1, significantly improves risk evaluation and prediction of CVD, hence calling for an update of guidelines.

Introduction: Hypercholesterolemia and other dyslipidemias are common risk factors for cardiovascular diseases (CVD) and development of atherosclerosis. International guidelines recommend LDL-C, non-HDL-C, and apoB under some conditions for clinical use in evaluating risk of CVD. In part 2 of this review, newer risk factor data for apoA-1, and the apoB/apoA-1 ratio is presented for atherosclerotic plaques, HDL-C versus apoA-1, inflammatory diseases, cancer, and metastases. Compared to conventional lipids, these apolipoproteins add strong clinical risk information for these CVD disorders and for a range of other diseases.

Areas covered: Prospective studies, reviews, meta-analyses, case control, nested-case, and therapeutic studies are analyzed. Searches were conducted with Google and in PubMed, and CVD journals for peer-reviewed publications. In part 1 of this review, newer risk factor data for apoA-1 and the apoB/apoA-1 ratio are presented for cardiovascular, cerebrovascular, diabetes, and other CVD manifestations of atherosclerosis.

Expert opinion: Strong associations between apoB, apoA-1 and especially the apoB/apoA-1 ratio and development of atherosclerosis-related risk of multiple CVD diseases have been documented world-wide. These data indicate that the balance, i.e. the ratio between the atherogenic apoB and the protective apoA-1, significantly improves risk evaluation and prediction of CVD, hence calling for an update of guidelines.

Introduction: With the substantial increase in direct oral anticoagulant (DOAC) usage, prescribers face complex decisions regarding the appropriate agent selection. This scoping review aimed to identify factors influencing oral anticoagulant choice in clinical practice over time.

Methods: Four databases (Medline, Embase, Scopus, Web of Science) were searched for quantitative observational studies on patients prescribed DOACs for any indication, focusing on factors affecting OAC choice. Studies published from January 2010 to March 2023 were included.

Results: Of the 4659 identified studies, 60 met selection criteria. Most (96%) examined the choice between DOACs and vitamin K antagonists (VKA); while (15%) evaluated factors affecting choice among DOACs. Age and gender were included in 77% and 70% of studies, respectively. Renal impairment (58%), heart failure (48%), previous stroke (43%), and thromboembolic risk (43%) were also commonly assessed. Older age had a significant negative association with DOAC prescribing in (50%) of the studies; renal impairment reduced DOAC initiation, favoring warfarin in (94%).

Conclusions: Several significant key factors were identified as being associated with OAC choice, including demographic factors such as age, and clinical factors such as kidney function, prior stroke, and other comorbidities. Significant factors in the choice among DOACs were advanced age, and renal impairment.

Registration: This systematic review was registered as a PURE protocol (https://pureportal.strath.ac.uk/en/projects/factors-associated-with-the-prescribing-of-direct-acting-oral-ant).

Introduction: In-stent calcification is recognized as a significant contributor to unfavorable clinical outcomes. Understanding the various types and underlying mechanisms of in-stent calcification can help interventional operators to make decisions.

Areas covered: This review will describe the distinct types of in-stent calcification, which are categorized into in-stent smooth calcification and in-stent calcified nodule. The mechanisms and characteristics of in-stent smooth calcification and calcified nodule will be summarized. Given the differences between these two types, treatment approaches will be discussed. This review will focus on histopathology and intracoronary imaging. For the purpose of this review, evidence was gathered from electronic literature searches via PubMed, with a particular focus on primary evidence published in the last 5 years.

Expert opinion: Several treatment devices are available such as conventional balloon, modified balloon, atherectomy device, and intravascular lithotripsy. In-stent smooth calcification and calcified nodule might result in different clinical courses after repeated target lesion revascularization. Understanding the mechanisms with the various types of in-stent calcification may assist operators in selecting appropriate treatment strategies.