Percutaneous coronary interventions (PCI) are the mainstay of treating obstructive coronary artery disease. However, procedural planning and individualization of the procedure is necessary for different patient phenotypes to optimize outcomes. Specifically, post-PCI pharmacotherapy with antiplatelets complicates the management of patients at high bleeding risk due to comorbidities, such as atrial fibrillation. Aiming to limit post-procedural adverse events and reduce the procedure-related bleeding risk, several novel technologies and hypotheses have been tested in clinical practice. Such frontiers include limiting the duration of dual antiplatelet therapy or even prescribing single regimens, using drug-coated balloons for performing the intervention and the effect of imaging-guided PCI in optimizing stent expansion. Furthermore, specific instruction in different patient phenotypes, such as atrial fibrillation and chronic kidney disease, are emerging, as despite both pathologies being considered at high bleeding risk, one size does not fit all. Thus, our review will provide all the recent updates on the field as well as algorithms and expert opinions on how to manage this, particularly common, phenotype of patient.
{"title":"Optimal management of high bleeding risk patients undergoing percutaneous coronary interventions: Where do we stand?","authors":"Kyriakos Dimitriadis MD, PhD, Nikolaos Pyrpyris MD, Panagiotis Iliakis MD, Panagiotis Kanatas MD, Panagiotis Theofilis MD, PhD, Athanasios Sakalidis MD, Anastasios Apostolos MD, Panagiotis Tsioufis MD, Aggelos Papanikolaou MD, Konstantinos Aznaouridis MD, PhD, Konstantina Aggeli MD, PhD, Konstantinos Tsioufis MD, PhD","doi":"10.1016/j.jjcc.2024.08.002","DOIUrl":"10.1016/j.jjcc.2024.08.002","url":null,"abstract":"<div><div>Percutaneous coronary interventions (PCI) are the mainstay of treating obstructive coronary artery disease. However, procedural planning and individualization of the procedure is necessary for different patient phenotypes to optimize outcomes. Specifically, post-PCI pharmacotherapy with antiplatelets complicates the management of patients at high bleeding risk due to comorbidities, such as atrial fibrillation. Aiming to limit post-procedural adverse events and reduce the procedure-related bleeding risk, several novel technologies and hypotheses have been tested in clinical practice. Such frontiers include limiting the duration of dual antiplatelet therapy or even prescribing single regimens, using drug-coated balloons for performing the intervention and the effect of imaging-guided PCI in optimizing stent expansion. Furthermore, specific instruction in different patient phenotypes, such as atrial fibrillation and chronic kidney disease, are emerging, as despite both pathologies being considered at high bleeding risk, one size does not fit all. Thus, our review will provide all the recent updates on the field as well as algorithms and expert opinions on how to manage this, particularly common, phenotype of patient.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 79-87"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this study of 19,824 ST-elevated myocardial infarction (STEMI) patients from the J-PCI OUTCOME registry (January 1, 2017, to December 31, 2018), we investigated the association between door-to-balloon time (DTB) and 1-year post-discharge cardiovascular outcomes. Patients with DTB >90 min were older and had higher comorbidities. The incidence of 1-year major adverse cardiovascular events (MACE) showed an incremental increase: 3.7 %, 4.8 %, and 7.7 % for DTB ≤60, DTB 60–90, and DTB >90 groups, respectively. Adjusted hazard ratios (aHR) compared to the DTB 60–90 group were 0.83 (DTB ≤60, p = 0.03) and 1.25 (DTB >90, p = 0.005). Subgroup analysis revealed higher risk for MACE in DTB >90 group for patients aged <70, men, no history of coronary revascularization, and those with cardiac arrest or cardiogenic shock. Conversely, DTB ≤60 group without previous history had a lower MACE risk (aHR 0.80, p = 0.02). This study, the largest of its kind, demonstrates that a DTB below 90 min is associated with lower 1-year MACE risk, supporting current guidelines, and indicating additional benefits for specific patient subgroups, especially those experiencing their first acute coronary event. The findings suggest the importance of early intervention in primary prevention and emphasize the need for prompt detection of vulnerable plaque.
{"title":"Association of door-to-balloon time and one-year outcomes in hospital survivors of ST-elevation myocardial infarction","authors":"Mitsuaki Sawano MD, PhD , Shun Kohsaka MD, PhD , Karthik Murugiah MBBS , Hideki Ishii MD, PhD, FJCC , Kyohei Yamaji MD, PhD , Jun Takahashi MD, PhD, FJCC , Kazuyuki Ozaki MD, PhD, FJCC , Tetsuya Amano MD, PhD , Ken Kozuma MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.06.009","DOIUrl":"10.1016/j.jjcc.2024.06.009","url":null,"abstract":"<div><div>In this study of 19,824 ST-elevated myocardial infarction (STEMI) patients from the J-PCI OUTCOME registry (January 1, 2017, to December 31, 2018), we investigated the association between door-to-balloon time (DTB) and 1-year post-discharge cardiovascular outcomes. Patients with DTB >90 min were older and had higher comorbidities. The incidence of 1-year major adverse cardiovascular events (MACE) showed an incremental increase: 3.7 %, 4.8 %, and 7.7 % for DTB ≤60, DTB 60–90, and DTB >90 groups, respectively. Adjusted hazard ratios (aHR) compared to the DTB 60–90 group were 0.83 (DTB ≤60, <em>p</em> = 0.03) and 1.25 (DTB >90, <em>p</em><span><span> = 0.005). Subgroup analysis revealed higher risk for MACE in DTB >90 group for patients aged <70, men, no history of coronary revascularization, and those with cardiac arrest or </span>cardiogenic shock. Conversely, DTB ≤60 group without previous history had a lower MACE risk (aHR 0.80, </span><em>p</em><span> = 0.02). This study, the largest of its kind, demonstrates that a DTB below 90 min is associated with lower 1-year MACE risk, supporting current guidelines, and indicating additional benefits for specific patient subgroups, especially those experiencing their first acute coronary event. The findings suggest the importance of early intervention in primary prevention and emphasize the need for prompt detection of vulnerable plaque.</span></div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 98-99"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Impella (Abiomed, Danvers, MA, USA) is a percutaneous ventricular assist device commonly used in cardiogenic shock, providing robust hemodynamic support, improving the systemic circulation, and relieving pulmonary congestion. Maintaining adequate left ventricular (LV) filling is essential for optimal hemodynamic support by Impella. This study aimed to investigate the impact of pulmonary vascular resistance (PVR) and right ventricular (RV) function on Impella-supported hemodynamics in severe biventricular failure using cardiovascular simulation.
Methods
We used Simulink® (Mathworks, Inc., Natick, MA, USA) for the simulation, incorporating pump performance of Impella CP determined using a mock circulatory loop. Both systemic and pulmonary circulation were modeled using a 5-element resistance–capacitance network. The four cardiac chambers were represented by time-varying elastance with unidirectional valves. In the scenario of severe LV dysfunction (LV end-systolic elastance set at a low level of 0.4 mmHg/mL), we compared the changes in right (RAP) and left atrial pressures (LAP), total systemic flow, and pressure–volume loop relationship at varying degrees of RV function, PVR, and Impella flow rate.
Results
The simulation results showed that under low PVR conditions, an increase in Impella flow rate slightly reduced RAP and LAP and increased total systemic flow, regardless of RV function. Under moderate RV dysfunction and high PVR conditions, an increase in Impella flow rate elevated RAP and excessively reduced LAP to induce LV suction, which limited the increase in total systemic flow.
Conclusions
PVR is the primary determinant of stable and effective Impella hemodynamic support in patients with severe biventricular failure.
{"title":"Impact of right ventricular and pulmonary vascular characteristics on Impella hemodynamic support in biventricular heart failure: A simulation study","authors":"Hiroki Matsushita MD , Keita Saku MD, PhD , Takuya Nishikawa MD, PhD , Takashi Unoki MD , Shohei Yokota MD , Kei Sato MD , Hidetaka Morita MD, PhD , Yuki Yoshida BE , Masafumi Fukumitsu MD, PhD , Kazunori Uemura MD, PhD , Toru Kawada MD, PhD , Atsushi Kikuchi MD , Ken Yamaura MD, PhD","doi":"10.1016/j.jjcc.2024.07.008","DOIUrl":"10.1016/j.jjcc.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Impella (Abiomed, Danvers, MA, USA) is a percutaneous ventricular assist device commonly used in cardiogenic shock, providing robust hemodynamic support, improving the systemic circulation, and relieving pulmonary congestion. Maintaining adequate left ventricular (LV) filling is essential for optimal hemodynamic support by Impella. This study aimed to investigate the impact of pulmonary vascular resistance (PVR) and right ventricular (RV) function on Impella-supported hemodynamics in severe biventricular failure using cardiovascular simulation.</div></div><div><h3>Methods</h3><div>We used Simulink® (Mathworks, Inc., Natick, MA, USA) for the simulation, incorporating pump performance of Impella CP determined using a mock circulatory loop. Both systemic and pulmonary circulation were modeled using a 5-element resistance–capacitance network. The four cardiac chambers were represented by time-varying elastance with unidirectional valves. In the scenario of severe LV dysfunction (LV end-systolic elastance set at a low level of 0.4 mmHg/mL), we compared the changes in right (RAP) and left atrial pressures (LAP), total systemic flow, and pressure–volume loop relationship at varying degrees of RV function, PVR, and Impella flow rate.</div></div><div><h3>Results</h3><div>The simulation results showed that under low PVR conditions, an increase in Impella flow rate slightly reduced RAP and LAP and increased total systemic flow, regardless of RV function. Under moderate RV dysfunction and high PVR conditions, an increase in Impella flow rate elevated RAP and excessively reduced LAP to induce LV suction, which limited the increase in total systemic flow.</div></div><div><h3>Conclusions</h3><div>PVR is the primary determinant of stable and effective Impella hemodynamic support in patients with severe biventricular failure.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 100-107"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jjcc.2024.08.003
Junyan Zhang MD , Zhongxiu Chen MD , Li Rao MD, Yong He MD
Percutaneous coronary intervention is a critical treatment for coronary artery disease, particularly myocardial infarction, and is highly recommended in clinical guidelines. Traditional metallic stents, although initially effective, remain permanently in the artery and can lead to complications such as in-stent restenosis, late thrombosis, and chronic inflammation. Given the temporary need for stenting and the potential for late complications, bioresorbable stents have emerged as a promising alternative. However, bioresorbable polymeric stents have encountered significant clinical challenges due to their low mechanical strength and ductility, which increase the risks of thrombosis and local inflammation. Consequently, bioresorbable metals are being considered as a superior option for coronary stents. This review examines the progress of bioresorbable metallic stents from both preclinical and clinical perspectives, aiming to provide a theoretical foundation for future research. Iron, zinc, and magnesium are the primary materials used for these stents. Zinc-based bioresorbable stents have shown promise in preclinical studies due to their biocompatibility and vascular protective properties, although human clinical studies are still limited. Magnesium-based stents have demonstrated positive clinical outcomes, being fully absorbed within 12 months and showing low rates of late lumen loss and target lesion failure at 6- and 12-months post-implantation. Initial trials of iron-based stents have indicated favorable mid-term safety and efficacy, with complete absorption by the body within three years and consistent luminal expansion beyond six months post-implantation. Despite these advancements, further trials are needed for comprehensive validation. In conclusion, while current materials do not fully meet the ideal requirements, ongoing research should focus on developing bioresorbable stents with enhanced performance characteristics to better meet clinical needs.
{"title":"Coronary bioresorbable metallic stents: Advancements and future perspectives","authors":"Junyan Zhang MD , Zhongxiu Chen MD , Li Rao MD, Yong He MD","doi":"10.1016/j.jjcc.2024.08.003","DOIUrl":"10.1016/j.jjcc.2024.08.003","url":null,"abstract":"<div><div>Percutaneous coronary intervention is a critical treatment for coronary artery disease, particularly myocardial infarction, and is highly recommended in clinical guidelines. Traditional metallic stents, although initially effective, remain permanently in the artery and can lead to complications such as in-stent restenosis, late thrombosis, and chronic inflammation. Given the temporary need for stenting and the potential for late complications, bioresorbable stents have emerged as a promising alternative. However, bioresorbable polymeric stents have encountered significant clinical challenges due to their low mechanical strength and ductility, which increase the risks of thrombosis and local inflammation. Consequently, bioresorbable metals are being considered as a superior option for coronary stents. This review examines the progress of bioresorbable metallic stents from both preclinical and clinical perspectives, aiming to provide a theoretical foundation for future research. Iron, zinc, and magnesium are the primary materials used for these stents. Zinc-based bioresorbable stents have shown promise in preclinical studies due to their biocompatibility and vascular protective properties, although human clinical studies are still limited. Magnesium-based stents have demonstrated positive clinical outcomes, being fully absorbed within 12 months and showing low rates of late lumen loss and target lesion failure at 6- and 12-months post-implantation. Initial trials of iron-based stents have indicated favorable mid-term safety and efficacy, with complete absorption by the body within three years and consistent luminal expansion beyond six months post-implantation. Despite these advancements, further trials are needed for comprehensive validation. In conclusion, while current materials do not fully meet the ideal requirements, ongoing research should focus on developing bioresorbable stents with enhanced performance characteristics to better meet clinical needs.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 69-78"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac arrest (CA) affects over 600,000 patients in the USA annually. Despite large-scale public health and educational initiatives, survival rates are lower in certain racial and socioeconomic groups.
Methods
A county-level cross-sectional longitudinal study using death data of patients aged 15 years or more from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2020. CAs were identified using the International Classification of Diseases, tenth revision, clinical modification codes.
Results
The CA-related deaths between 1999 and 2020 were 7,710,211 in the entire USA. The annual CA related age-adjusted mortality rates (CA-MR) declined through 2019 (132.9 to 89.7 per 100,000 residents), followed by an increase in 2020 (104.5 per 100,000). White patients constituted 82 % of all deaths and 51 % were female. The overall CA-MR during the study period was 104.48 per 100,000 persons. The CA-MR was higher for men as compared with women (123.5 vs. 89.7 per 100,000) and higher for Black as compared with White adults (154.4 vs. 99.1 per 100,000).
Conclusions
CA-MR in the overall population has declined, followed by an increase in 2020, which is likely the impact of the COVID-19 pandemic. There were also significant racial and sex differences in mortality rates.
背景：在美国，每年有 60 多万名患者因心脏骤停（CA）而死亡。尽管采取了大规模的公共卫生和教育措施，但某些种族和社会经济群体的存活率较低：一项县级横断面纵向研究使用了美国疾病控制和预防中心的广泛流行病学研究在线数据（WONDER）数据库中 1999 年至 2020 年期间 15 岁或以上患者的死亡数据。CA使用《国际疾病分类》第十版的临床修改代码进行识别：结果：1999 年至 2020 年间，全美与 CA 相关的死亡人数为 7,710,211 人。与 CA 相关的年度年龄调整死亡率（CA-MR）在 2019 年有所下降（从每 10 万居民 132.9 例降至 89.7 例），随后在 2020 年有所上升（每 10 万居民 104.5 例）。白人患者占所有死亡人数的 82%，女性占 51%。研究期间的总体 CA-MR 为每 10 万人 104.48 例。与女性相比，男性的 CA-MR 较高（123.5 vs. 89.7 per 100,000），与白人相比，黑人的 CA-MR 较高（154.4 vs. 99.1 per 100,000）：结论：总人口中的 CA-MR 有所下降，2020 年有所上升，这可能是 COVID-19 大流行的影响。死亡率也存在明显的种族和性别差异。
{"title":"Temporal Trends in Race and Sex Differences in Cardiac Arrest Mortality in the USA, 1999–2020","authors":"Karthik Gonuguntla MD , Muchi Ditah Chobufo MD, MPH , Ayesha Shaik MD , Nicholas Roma MD , Mouna Penmetsa MD , Harshith Thyagaturu MD , Neel Patel MD , Amro Taha MD , Waleed Alruwaili MD, MPH , Raahat Bansal MD , Muhammad Zia Khan MD, MS , Yasar Sattar MD , Sudarshan Balla MD","doi":"10.1016/j.jjcc.2024.08.006","DOIUrl":"10.1016/j.jjcc.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac arrest (CA) affects over 600,000 patients in the USA annually. Despite large-scale public health and educational initiatives, survival rates are lower in certain racial and socioeconomic groups.</div></div><div><h3>Methods</h3><div>A county-level cross-sectional longitudinal study using death data of patients aged 15 years or more from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2020. CAs were identified using the International Classification of Diseases, tenth revision, clinical modification codes.</div></div><div><h3>Results</h3><div>The CA-related deaths between 1999 and 2020 were 7,710,211 in the entire USA. The annual CA related age-adjusted mortality rates (CA-MR) declined through 2019 (132.9 to 89.7 per 100,000 residents), followed by an increase in 2020 (104.5 per 100,000). White patients constituted 82 % of all deaths and 51 % were female. The overall CA-MR during the study period was 104.48 per 100,000 persons. The CA-MR was higher for men as compared with women (123.5 vs. 89.7 per 100,000) and higher for Black as compared with White adults (154.4 vs. 99.1 per 100,000).</div></div><div><h3>Conclusions</h3><div>CA-MR in the overall population has declined, followed by an increase in 2020, which is likely the impact of the COVID-19 pandemic. There were also significant racial and sex differences in mortality rates.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 63-68"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) due to the occlusion of left coronary artery are worse in patients with proximal occlusion than in those with non-proximal occlusion. However, there are few reports that focus on the comparison of clinical outcomes in patients with STEMI between proximal and non-proximal right coronary artery (RCA) occlusions.
Methods
We included 356 patients with STEMI whose infarct-related artery is RCA and divided them into the proximal group (n = 129) and the non-proximal group (n = 227). We defined segment 1 of RCA as proximal, and segments 2, 3, and 4 as non-proximal according to the reporting system of the American Heart Association. The primary endpoint was major cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization.
Results
Incidence of shock at admission, requirement for catecholamine during percutaneous coronary intervention (PCI), or mechanical support during PCI tended to be higher in the proximal group (42.6 %) than in the non-proximal group (33.5 %) (p = 0.088). Although the incidence of right ventricular infarction tended to be higher in the proximal group (17.8 %) than in the non-proximal group (10.6 %) without reaching statistical significance (p = 0.072), the incidence of in-hospital death was similar between the 2 groups (1.6 % versus 1.8 %, p = 1.000). The MACE-free survival curves were not different between the 2 groups (p = 0.400). Multivariate Cox hazard analysis revealed that proximal RCA occlusion was not associated with MACE (HR 1.095, 95%CI 0.691–1.737, p = 0.699).
Conclusions
Although the acute phase conditions such as shock or right ventricular infarction tended to be more severe in patients with proximal occlusion, overall clinical outcomes including long-term outcomes were comparable between the proximal and distal RCA occlusions. Furthermore, multivariate analysis showed that the proximal RCA occlusion was not associated with MACE after hospital discharge.
{"title":"Comparison of clinical outcomes between proximal and non-proximal right coronary artery occlusion in patients with inferior ST-segment elevation myocardial infarction","authors":"Koudai Hamaguchi MD, Kenichi Sakakura MD, Hiroyuki Jinnouchi MD, Yousuke Taniguchi MD, Kei Yamamoto MD, Takunori Tsukui MD, Masashi Hatori MD, Taku Kasahara MD, Yusuke Watanabe MD, Shun Ishibashi MD, Masaru Seguchi MD, Hideo Fujita MD, FJCC","doi":"10.1016/j.jjcc.2024.07.007","DOIUrl":"10.1016/j.jjcc.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) due to the occlusion of left coronary artery are worse in patients with proximal occlusion than in those with non-proximal occlusion. However, there are few reports that focus on the comparison of clinical outcomes in patients with STEMI between proximal and non-proximal right coronary artery (RCA) occlusions.</div></div><div><h3>Methods</h3><div>We included 356 patients with STEMI whose infarct-related artery is RCA and divided them into the proximal group (<em>n</em> = 129) and the non-proximal group (<em>n</em> = 227). We defined segment 1 of RCA as proximal, and segments 2, 3, and 4 as non-proximal according to the reporting system of the American Heart Association. The primary endpoint was major cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization.</div></div><div><h3>Results</h3><div>Incidence of shock at admission, requirement for catecholamine during percutaneous coronary intervention (PCI), or mechanical support during PCI tended to be higher in the proximal group (42.6 %) than in the non-proximal group (33.5 %) (<em>p</em> = 0.088). Although the incidence of right ventricular infarction tended to be higher in the proximal group (17.8 %) than in the non-proximal group (10.6 %) without reaching statistical significance (<em>p</em> = 0.072), the incidence of in-hospital death was similar between the 2 groups (1.6 % versus 1.8 %, <em>p</em> = 1.000). The MACE-free survival curves were not different between the 2 groups (<em>p</em> = 0.400). Multivariate Cox hazard analysis revealed that proximal RCA occlusion was not associated with MACE (HR 1.095, 95%CI 0.691–1.737, <em>p</em> = 0.699).</div></div><div><h3>Conclusions</h3><div>Although the acute phase conditions such as shock or right ventricular infarction tended to be more severe in patients with proximal occlusion, overall clinical outcomes including long-term outcomes were comparable between the proximal and distal RCA occlusions. Furthermore, multivariate analysis showed that the proximal RCA occlusion was not associated with MACE after hospital discharge.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 88-95"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.jjcc.2025.01.012
Paolo Basile, Andrea Igoren Guaricci
{"title":"Author's reply to the Letter to the Editor \"How to demonstrate the causal relationship between sodium-glucose cotransporter 2 receptor and prevention of ventricular arrhythmia in heart failure cohorts\".","authors":"Paolo Basile, Andrea Igoren Guaricci","doi":"10.1016/j.jjcc.2025.01.012","DOIUrl":"10.1016/j.jjcc.2025.01.012","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial fibrillation (AF) is the most common arrhythmia worldwide and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke, yet an estimated 50 % of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation (OAC). In patients with AF, the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the past two decades as a valuable alternative to OAC for reducing the risk of strokes and systemic embolisms in patients with AF who cannot tolerate long-term OAC. With newer generation devices such as the Watchman (Boston Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA) gaining approval from the US Food and Drug Administration in recent years, the safety and efficacy of LAAC in specific populations intolerant to OAC have increased and more patients are being treated. This systematic review provides the indications for LAAC and the evidence for evaluating the use of the currently available device therapies. We also examine the current unsolved problems with patient selection and postprocedural antithrombotic regimens.
{"title":"Current evidence and indications for left atrial appendage closure.","authors":"Masaya Shinohara, Mike Saji, Hideki Koike, Hiroshi Ohara, Yoshinari Enomoto, Rine Nakanishi, Tadashi Fujino, Takanori Ikeda","doi":"10.1016/j.jjcc.2025.01.014","DOIUrl":"10.1016/j.jjcc.2025.01.014","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common arrhythmia worldwide and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke, yet an estimated 50 % of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation (OAC). In patients with AF, the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the past two decades as a valuable alternative to OAC for reducing the risk of strokes and systemic embolisms in patients with AF who cannot tolerate long-term OAC. With newer generation devices such as the Watchman (Boston Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA) gaining approval from the US Food and Drug Administration in recent years, the safety and efficacy of LAAC in specific populations intolerant to OAC have increased and more patients are being treated. This systematic review provides the indications for LAAC and the evidence for evaluating the use of the currently available device therapies. We also examine the current unsolved problems with patient selection and postprocedural antithrombotic regimens.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1016/j.jjcc.2025.01.013
Yu Horiuchi, Yuya Matsue, Nicholas Wettersten, Shogo Oishi, Eiichi Akiyama, Satoshi Suzuki, Masayoshi Yamamoto, Keisuke Kida, Takahiro Okumura, Takeshi Kitai, Dirk J van Veldhuisen, Alan Maisel, Patrick T Murray, Tohru Minamino
Background: Whether variability of B-type natriuretic peptide (BNP) values between races affects its clinical integration as a marker for congestion and predictor of prognosis in acute heart failure (AHF) remains unknown. We aimed to investigate the relationship between diuretic therapy, change in BNP value, and prognosis in AHF in relation to racial differences.
Methods: This analysis combined data from the AKINESIS and REALITY-AHF studies. We included White, Black, and Asian individuals admitted with AHF requiring intravenous diuretic therapy. We examined the relative change in BNP values at 48 h post hospital admission, and its association with diuretic therapy and one-year mortality.
Results: Of 1380 participants, 29 % were White, 12 % were Black, and 58 % were Asian. Admission BNP values were highest in Black, followed by Asian and White individuals. After adjusting for confounding factors, Black individuals had significantly higher admission BNP values compared to White individuals. During the first 48 h of hospitalization, Asian individuals received the lowest diuretic dose but demonstrated the greatest diuretic response and BNP decrease. After adjustment for confounding factors, Asian individuals were more likely to have a BNP decrease compared to White individuals. Higher admission BNP values predicted higher one-year mortality in White and Asian but not in Black individuals (p for interaction = 0.021). BNP decrease was associated with a lower one-year mortality without a significant interaction by race.
Conclusions: In AHF patients, admission BNP was higher in Black, and its decrease after diuretic therapy was greater in Asian individuals. A BNP decrease predicted a better prognosis, regardless of race.
{"title":"Racial differences in diuretic therapy, B-type natriuretic peptide values, and prognosis in acute heart failure.","authors":"Yu Horiuchi, Yuya Matsue, Nicholas Wettersten, Shogo Oishi, Eiichi Akiyama, Satoshi Suzuki, Masayoshi Yamamoto, Keisuke Kida, Takahiro Okumura, Takeshi Kitai, Dirk J van Veldhuisen, Alan Maisel, Patrick T Murray, Tohru Minamino","doi":"10.1016/j.jjcc.2025.01.013","DOIUrl":"10.1016/j.jjcc.2025.01.013","url":null,"abstract":"<p><strong>Background: </strong>Whether variability of B-type natriuretic peptide (BNP) values between races affects its clinical integration as a marker for congestion and predictor of prognosis in acute heart failure (AHF) remains unknown. We aimed to investigate the relationship between diuretic therapy, change in BNP value, and prognosis in AHF in relation to racial differences.</p><p><strong>Methods: </strong>This analysis combined data from the AKINESIS and REALITY-AHF studies. We included White, Black, and Asian individuals admitted with AHF requiring intravenous diuretic therapy. We examined the relative change in BNP values at 48 h post hospital admission, and its association with diuretic therapy and one-year mortality.</p><p><strong>Results: </strong>Of 1380 participants, 29 % were White, 12 % were Black, and 58 % were Asian. Admission BNP values were highest in Black, followed by Asian and White individuals. After adjusting for confounding factors, Black individuals had significantly higher admission BNP values compared to White individuals. During the first 48 h of hospitalization, Asian individuals received the lowest diuretic dose but demonstrated the greatest diuretic response and BNP decrease. After adjustment for confounding factors, Asian individuals were more likely to have a BNP decrease compared to White individuals. Higher admission BNP values predicted higher one-year mortality in White and Asian but not in Black individuals (p for interaction = 0.021). BNP decrease was associated with a lower one-year mortality without a significant interaction by race.</p><p><strong>Conclusions: </strong>In AHF patients, admission BNP was higher in Black, and its decrease after diuretic therapy was greater in Asian individuals. A BNP decrease predicted a better prognosis, regardless of race.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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