Pub Date : 2026-01-01DOI: 10.1001/jamacardio.2025.4450
Sridhar Mangalesh, Michael G Nanna
{"title":"Lipoprotein(a) Elevation for Refining Risk Stratification With the PREVENT Equations.","authors":"Sridhar Mangalesh, Michael G Nanna","doi":"10.1001/jamacardio.2025.4450","DOIUrl":"10.1001/jamacardio.2025.4450","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"107"},"PeriodicalIF":14.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714305","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 : 2026-01-01DOI: 10.1001/jamacardio.2025.4588
Janani Rangaswami, Katherine R Tuttle
{"title":"Prerenalism-A Gap That Costs Lives, Hearts, and Kidneys.","authors":"Janani Rangaswami, Katherine R Tuttle","doi":"10.1001/jamacardio.2025.4588","DOIUrl":"10.1001/jamacardio.2025.4588","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"82-83"},"PeriodicalIF":14.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477009","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 : 2025-12-23DOI: 10.1001/jamacardio.2025.4824
Stephen J Nicholls,Donna H Ryan,John Deanfield,Daniel Ferreira,Chim C Lang,A Michael Lincoff,Ildiko Lingvay,Christopher Lübker,Paula Pérez Terns,Søren Rasmussen,Signe Stensen,Peter E Weeke,Steven E Kahn,
ImportanceThe primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown.ObjectiveTo determine the impact of semaglutide on total hospital admissions and duration of hospital stay.Design, Setting, and ParticipantsThe SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025.InterventionsOnce-weekly subcutaneous semaglutide, 2.4 mg, or placebo.Main Outcomes and MeasuresThe total number of hospital admissions and days in hospital between the semaglutide and placebo groups.ResultsA total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex.Conclusions and RelevanceIn this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction.Trial RegistrationClinicalTrials.gov Identifier: NCT03574597.
SELECT随机临床试验的初步分析表明，semaglutide降低了心血管疾病（CVD）和超重或肥胖无糖尿病患者心血管（CV）死亡、心肌梗死和卒中的发生率。然而，西马鲁肽对该人群住院治疗的影响尚不清楚。目的探讨西马鲁肽对住院总人数和住院时间的影响。设计、环境和参与者：SELECT试验纳入了年龄在45岁或以上、患有心血管疾病、体重指数（BMI，以体重公斤除以身高米的平方计算）为27或更高、无糖尿病的患者，这些患者来自北美、南美、欧洲、亚洲、非洲和澳大利亚的804个临床环境。患者于2018年10月至2021年3月随机分组。这项预先指定的探索性分析于2024年2月至2025年9月进行。干预：每周一次皮下注射西马鲁肽，2.4 mg，或安慰剂。主要结局和测量：西马鲁肽组和安慰剂组的住院总次数和住院天数。结果共随访17 604例患者，中位[IQR]年龄61.0[55.0 ~ 68.0]岁，女性4872例（27.7%），中位[IQR] BMI 32.1[29.7 ~ 35.7])，中位（IQR）时间41.8（33.0 ~ 47.0）个月。住院11人次 287人次。在任何适应症中，西马鲁肽组的总住院次数都低于安慰剂组(18.3次/ 100患者年vs 20.4次/ 100患者年；平均比率[MR]， 0.90; 95% CI, 0.85-0.95; P <。0.001)和严重不良事件（15.2 vs 17.1 / 100患者年入院；MR, 0.89; 95% CI, 0.84-0.94; P < 0.001）。西马鲁肽组每100患者年因任何适应症住院的天数低于安慰剂组(157.2天vs 176.2天；比率比[RR]， 0.89; 95% CI, 0.82-0.98; P =。01)，以及因严重不良事件住院（137.6天vs 153.9天；RR, 0.89; 95% CI, 0.81-0.98; P = 0.02）。在选定的亚组（包括BMI、年龄和性别）中，未观察到西马鲁肽减少住院率的异质性。结论和相关性在这个预先指定的探索性分析的SELECT随机临床试验中，试验队列的住院率很高。每周一次的西马鲁肽治疗与住院率和住院总时间的显著降低相关，其益处超出了降低心血管风险的范围。临床试验注册号：NCT03574597。
{"title":"Semaglutide and Hospitalizations in Patients With Obesity and Established Cardiovascular Disease: An Exploratory Analysis of the SELECT Randomized Clinical Trial.","authors":"Stephen J Nicholls,Donna H Ryan,John Deanfield,Daniel Ferreira,Chim C Lang,A Michael Lincoff,Ildiko Lingvay,Christopher Lübker,Paula Pérez Terns,Søren Rasmussen,Signe Stensen,Peter E Weeke,Steven E Kahn, ","doi":"10.1001/jamacardio.2025.4824","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4824","url":null,"abstract":"ImportanceThe primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown.ObjectiveTo determine the impact of semaglutide on total hospital admissions and duration of hospital stay.Design, Setting, and ParticipantsThe SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025.InterventionsOnce-weekly subcutaneous semaglutide, 2.4 mg, or placebo.Main Outcomes and MeasuresThe total number of hospital admissions and days in hospital between the semaglutide and placebo groups.ResultsA total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex.Conclusions and RelevanceIn this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction.Trial RegistrationClinicalTrials.gov Identifier: NCT03574597.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807645","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 : 2025-12-17DOI: 10.1001/jamacardio.2025.4561
Vidhu Anand,Robert O Bonow,Rick A Nishimura,Victoria Delgado,João L Cavalcante,Jyothy J Puthumana,Akhil Narang,Judy W Hung,James D Thomas,Lauren S Ranard,Vera H Rigolin
ImportancePrimary mitral regurgitation (MR) is a prevalent valvular lesion. Current American College of Cardiology/American Heart Association guidelines include class I recommendations for intervention for severe primary MR at the onset of symptoms, significant left ventricular (LV) enlargement (end-systolic dimension ≥40 mm), or dysfunction (ejection fraction ≤60%), with a class IIA recommendation for mitral valve repair when performed at an experienced surgical center. Recent data suggest a survival penalty when waiting for class I surgical guideline indications, and novel markers of decompensation are under investigation.ObservationsComprehensive assessment of MR severity using echocardiography is critical, and when warranted, cardiac magnetic resonance (CMR) is complementary. Assessment of LV size and function, as well as serial changes in both, is crucial for determining timing of surgery. New-onset atrial fibrillation, left atrial enlargement, pulmonary hypertension, and exercise-induced changes in LV function should also be considered in borderline scenarios. The roles of LV volumes, global longitudinal strain, CMR-derived measures of myocardial dysfunction, and cardiac biomarkers are worthy of further investigation regarding consideration for early surgical intervention.Conclusions and RelevanceA more refined approach incorporating assessment of extravalvular cardiac injury, novel imaging markers, and biomarkers is needed to optimize surgical timing in primary MR. Further research is warranted to validate these emerging parameters and refine guidelines to improve patient outcomes.
{"title":"Myocardial Dysfunction in Primary Mitral Regurgitation: A Review.","authors":"Vidhu Anand,Robert O Bonow,Rick A Nishimura,Victoria Delgado,João L Cavalcante,Jyothy J Puthumana,Akhil Narang,Judy W Hung,James D Thomas,Lauren S Ranard,Vera H Rigolin","doi":"10.1001/jamacardio.2025.4561","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4561","url":null,"abstract":"ImportancePrimary mitral regurgitation (MR) is a prevalent valvular lesion. Current American College of Cardiology/American Heart Association guidelines include class I recommendations for intervention for severe primary MR at the onset of symptoms, significant left ventricular (LV) enlargement (end-systolic dimension ≥40 mm), or dysfunction (ejection fraction ≤60%), with a class IIA recommendation for mitral valve repair when performed at an experienced surgical center. Recent data suggest a survival penalty when waiting for class I surgical guideline indications, and novel markers of decompensation are under investigation.ObservationsComprehensive assessment of MR severity using echocardiography is critical, and when warranted, cardiac magnetic resonance (CMR) is complementary. Assessment of LV size and function, as well as serial changes in both, is crucial for determining timing of surgery. New-onset atrial fibrillation, left atrial enlargement, pulmonary hypertension, and exercise-induced changes in LV function should also be considered in borderline scenarios. The roles of LV volumes, global longitudinal strain, CMR-derived measures of myocardial dysfunction, and cardiac biomarkers are worthy of further investigation regarding consideration for early surgical intervention.Conclusions and RelevanceA more refined approach incorporating assessment of extravalvular cardiac injury, novel imaging markers, and biomarkers is needed to optimize surgical timing in primary MR. Further research is warranted to validate these emerging parameters and refine guidelines to improve patient outcomes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"29 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765392","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 : 2025-12-17DOI: 10.1001/jamacardio.2025.4661
Jasper Boeddinghaus,Ziwen Li,Anda Bularga,Caelan Taggart,Ryan Wereski,Andrew R Chapman,Kuan Ken Lee,Christopher Tuck,Robyn Gunn,Sara Jenks,Kirsty McCance,Rebecca Pattenden,Jonathan Malo,Alexander J F Thurston,Yong Yong Tew,Michael McDermott,Alasdair Gray,Nicholas L M Cruden,Atul Anand,Dorien M Kimenai,Nicholas L Mills,
ImportanceHigh-sensitivity cardiac troponin T and I assays are considered equivalent for the diagnosis of myocardial infarction. However, the impact of transitioning from an assay measuring cardiac troponin I to one measuring cardiac troponin T on patient care and clinical outcomes is unknown.ObjectiveTo evaluate the impact of transitioning from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T on the care and outcomes of consecutive patients with suspected acute coronary syndrome.Design, Setting, and ParticipantsThis was a prospective, multicenter, interrupted time-series study conducted at 3 acute care centers. Consecutive patients presenting with suspected acute coronary syndrome to an acute care hospital were identified between October 2020 and October 2022.InterventionsAll sites changed from an assay measuring cardiac troponin I to one measuring cardiac troponin T in October 2021.Main Outcomes and MeasuresThe primary outcome was hospital admission.ResultsAmong 25 849 patients, 13 146 (median [IQR] age, 60 [47-73] years; 6961 male [53%]) and 12 703 (median [IQR] age, 60 [47-73] years; 6825 male [54%]) presented before and after the transition to cardiac troponin T, respectively. The proportion of patients with myocardial injury increased from 21% (2800 of 13 146 patients) to 38% (4781 of 12 703 patients), and patients were more likely to be admitted to the hospital after the transition (odds ratio [OR], 2.24; 95% CI, 1.81-2.77; both P < .001). A 6-fold increase in serial testing was observed in patients undergoing a measure of cardiac troponin T compared with cardiac troponin I (OR, 6.03; 95% CI, 4.85-7.49; P < .001). Subsequent myocardial infarction, heart failure, or cardiovascular death at 1 year was comparable before and after the transition (OR, 0.83; 95% CI, 0.48-1.41; P = .49).Conclusions and RelevanceThe transition from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T was associated with increased identification of myocardial injury, serial troponin measurements, and hospital admissions without evidence of improved cardiovascular outcomes at 1 year.Trial RegistrationClinicalTrials.gov Identifier: NCT05748691.
{"title":"Clinical Decisions and Outcomes After Switching High-Sensitivity Cardiac Troponin Assays in Suspected ACS: An Interrupted Time-Series Study.","authors":"Jasper Boeddinghaus,Ziwen Li,Anda Bularga,Caelan Taggart,Ryan Wereski,Andrew R Chapman,Kuan Ken Lee,Christopher Tuck,Robyn Gunn,Sara Jenks,Kirsty McCance,Rebecca Pattenden,Jonathan Malo,Alexander J F Thurston,Yong Yong Tew,Michael McDermott,Alasdair Gray,Nicholas L M Cruden,Atul Anand,Dorien M Kimenai,Nicholas L Mills, ","doi":"10.1001/jamacardio.2025.4661","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4661","url":null,"abstract":"ImportanceHigh-sensitivity cardiac troponin T and I assays are considered equivalent for the diagnosis of myocardial infarction. However, the impact of transitioning from an assay measuring cardiac troponin I to one measuring cardiac troponin T on patient care and clinical outcomes is unknown.ObjectiveTo evaluate the impact of transitioning from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T on the care and outcomes of consecutive patients with suspected acute coronary syndrome.Design, Setting, and ParticipantsThis was a prospective, multicenter, interrupted time-series study conducted at 3 acute care centers. Consecutive patients presenting with suspected acute coronary syndrome to an acute care hospital were identified between October 2020 and October 2022.InterventionsAll sites changed from an assay measuring cardiac troponin I to one measuring cardiac troponin T in October 2021.Main Outcomes and MeasuresThe primary outcome was hospital admission.ResultsAmong 25 849 patients, 13 146 (median [IQR] age, 60 [47-73] years; 6961 male [53%]) and 12 703 (median [IQR] age, 60 [47-73] years; 6825 male [54%]) presented before and after the transition to cardiac troponin T, respectively. The proportion of patients with myocardial injury increased from 21% (2800 of 13 146 patients) to 38% (4781 of 12 703 patients), and patients were more likely to be admitted to the hospital after the transition (odds ratio [OR], 2.24; 95% CI, 1.81-2.77; both P < .001). A 6-fold increase in serial testing was observed in patients undergoing a measure of cardiac troponin T compared with cardiac troponin I (OR, 6.03; 95% CI, 4.85-7.49; P < .001). Subsequent myocardial infarction, heart failure, or cardiovascular death at 1 year was comparable before and after the transition (OR, 0.83; 95% CI, 0.48-1.41; P = .49).Conclusions and RelevanceThe transition from a high-sensitivity assay measuring cardiac troponin I to one measuring cardiac troponin T was associated with increased identification of myocardial injury, serial troponin measurements, and hospital admissions without evidence of improved cardiovascular outcomes at 1 year.Trial RegistrationClinicalTrials.gov Identifier: NCT05748691.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"159 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765389","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 : 2025-12-17DOI: 10.1001/jamacardio.2025.4572
Yasser M Sammour,Wissam A Jaber,Neal S Kleiman
{"title":"Guideline Adherence in Myocardial Infarction Treatment-Reply.","authors":"Yasser M Sammour,Wissam A Jaber,Neal S Kleiman","doi":"10.1001/jamacardio.2025.4572","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4572","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"154 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765364","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 : 2025-12-17DOI: 10.1001/jamacardio.2025.4723
Jonas Dominik Häner,Ryota Kakizaki,Masanori Taniwaki,Yohei Ohno,Kazuyuki Yahagi,Yoshiharu Higuchi,George C M Siontis,Kenji Ando,Stefan Stortecky,Nobuaki Suzuki,Naoki Watanabe,Jonas Lanz,Yasushi Ueki,Tatsuhiko Otsuka,Flavio Giuseppe Biccirè,Masami Sakurada,Konstantinos C Koskinas,Sylvain Losdat,Lorenz Räber
ImportanceNeoatherosclerosis represents a major cause of late stent failure and results in cardiac events after drug-eluting stent (DES) implantation. Achieving secondary preventive low-density lipoprotein cholesterol (LDL-C) target levels can reduce plaque progression in native coronary arteries; however, its association with neoatherosclerosis formation remains unclear.ObjectiveTo determine whether achieving guideline-endorsed LDL-C levels after DES implantation is associated with reduced risk of long-term neoatherosclerosis formation.Design, Setting, and ParticipantsThis is a post hoc analysis of the CONNECT randomized clinical trial conducted at 7 sites in Switzerland and Japan that had randomized 239 patients with ST-segment elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) with biodegradable- or durable-polymer everolimus-eluting stents between June 2017 and June 2020. The prevalence of neoatherosclerosis was assessed with optical coherence tomography (OCT) 3 years after primary PCI. Data analysis for this post hoc analysis was conducted from September 2024 to October 2025.InterventionPatients with STEMI received primary PCI with DES, and statin therapy was recommended according to country-specific guidelines.Main Outcomes and MeasuresThe prevalence of neoatherosclerosis 3 years after primary PCI was compared between patients with vs without achievement of guideline-endorsed target LDL-C levels. A multivariable predictor analysis was performed to determine whether on-treatment LDL-C levels were associated with occurrence of neoatherosclerosis.ResultsAmong 178 patients (mean [SD] age, 63.4 [10.9] years; 27 [15%] female) who underwent OCT at 3 years, 98 patients (55%) achieved the target LDL-C level and 80 patients (45%) did not. The mean (SD) on-treatment LDL-C levels for these groups were 48 (13) and 87 (37) mg/dL, respectively (to convert to millimoles per liter, multiply by 0.0259). The prevalence of neoatherosclerosis was lower in patients who achieved the target LDL-C level as compared with patients who did not (7 patients [7%] vs 15 patients [19%], respectively; odds ratio for those who did not achieve the LDL-C target level, 3.00; 95% CI, 1.19-8.24; P = .02). On-treatment LDL-C level (per 25-mg/dL increase) emerged as an independent determinant of neoatherosclerosis at 3 years in multivariable logistic regression analysis (odds ratio, 1.46; 95% CI, 1.09-2.01; P = .01).Conclusions and RelevanceOn-treatment LDL-C level emerged as an independent predictor of neoatherosclerosis 3 years after DES implantation for STEMI. Neoatherosclerosis was less frequent among patients who achieved the guideline-recommended on-treatment LDL-C level, underscoring the importance of LDL-C lowering in preventing neoatherosclerosis formation.Trial RegistrationClinicalTrials.gov Identifier: NCT03440801.
动脉粥样硬化是药物洗脱支架（DES）植入后晚期支架失效和心脏事件的主要原因。达到二级预防低密度脂蛋白胆固醇（LDL-C）目标水平可以减少原生冠状动脉斑块的进展；然而，其与新动脉粥样硬化形成的关系尚不清楚。目的确定DES植入后达到指南认可的LDL-C水平是否与降低长期新动脉粥样硬化形成的风险相关。设计、环境和参与者：这是一项对瑞士和日本7个地点进行的CONNECT随机临床试验的事后分析，该试验于2017年6月至2020年6月期间随机纳入239名st段抬高型心肌梗死（STEMI）患者，使用可生物降解或耐用聚合物依维莫司洗脱支架进行经皮冠状动脉介入治疗（PCI）。首次PCI后3年，通过光学相干断层扫描（OCT）评估新动脉粥样硬化的患病率。该事后分析的数据分析于2024年9月至2025年10月进行。介入：STEMI患者在DES的基础上接受PCI治疗，他汀类药物治疗是根据国家特定指南推荐的。主要结果和测量方法：比较首次PCI后3年新动脉粥样硬化的患病率，患者与未达到指南认可的目标LDL-C水平的患者。进行多变量预测分析以确定治疗时LDL-C水平是否与新动脉粥样硬化的发生相关。结果178例患者（平均[SD]年龄63.4[10.9]岁，27例[15%]女性）在3岁时行OCT治疗，98例（55%）患者达到LDL-C目标水平，80例（45%）患者未达到目标水平。这两组治疗后LDL-C的平均（SD）水平分别为48（13）和87 (37)mg/dL（换算成每升毫摩尔，乘以0.0259）。与未达到LDL-C目标水平的患者相比，达到LDL-C目标水平的患者的新动脉粥样硬化患病率较低（分别为7例[7%]对15例[19%]；未达到LDL-C目标水平的患者的优势比为3.00;95% CI, 1.19-8.24; P = 0.02）。在多变量logistic回归分析中，治疗时LDL-C水平（每增加25毫克/分升）成为3年后新动脉粥样硬化的独立决定因素（优势比1.46;95% CI, 1.09-2.01; P = 0.01）。治疗后LDL-C水平成为STEMI患者植入DES 3年后新动脉粥样硬化的独立预测因子。在达到指南推荐的治疗时LDL-C水平的患者中，新动脉粥样硬化的发生率较低，强调了降低LDL-C在预防新动脉粥样硬化形成中的重要性。临床试验注册号：NCT03440801。
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