Pub Date : 2025-08-13DOI: 10.1016/j.rec.2025.07.005
Marco Vitolo , Marco Proietti , Marta Mantovani , Jacopo Francesco Imberti , Davide Antonio Mei , Niccolò Bonini , Giulio Francesco Romiti , Bernadette Corica , Igor Diemberger , Laurent Fauchier , Francisco Marín , Gheorghe-Andrei Dan , Tatjana S. Potpara , Gregory Y.H. Lip , Giuseppe Boriani
Introduction and objectives
Increased physical activity may improve outcomes in patients with atrial fibrillation (AF), but available data are limited. This study aimed to analyze the association between physical activity and major adverse outcomes in a large European AF cohort.
Methods
We used data from a prospective, observational, large-scale multicenter study of AF in European patients, involving 27 countries and 250 centers. Patients self-reported their physical activity levels during the preceding 2 years, categorized as none (physically inactive), occasional, regular, or intense. The primary outcome was a composite of major adverse cardiovascular (CV) events and all-cause mortality.
Results
A total of 9525 patients with AF were included (median age 71 years; 41% female). Overall, 43% reported being physically inactive. Among those who reported physical activity, 56.9% described it as occasional, 36.5% as regular, and 6.6% as intense. Inactive patients had a higher burden of both CV and non-CV comorbidities. Over a median follow-up of 728 days, 16.2% of the patients experienced the primary composite endpoint. Physical activity was independently associated with a lower risk of the primary endpoint (adjusted HR, 0.68; 95% CI, 0.59-0.76), with a progressively lower incidence as activity levels increased. Interaction analyses showed that the beneficial effect of physical activity was consistent among several subgroups, with no significant interactions.
Conclusions
Physical activity, even at low levels, was associated with a reduced incidence of CV events and all-cause mortality. These benefits appear to be independent of CV risk factors and comorbidities, highlighting the importance of incorporating physical activity into holistic AF management strategies.
{"title":"Physical activity in patients with atrial fibrillation and adverse outcomes: results from a large-scale prospective multicenter European cohort","authors":"Marco Vitolo , Marco Proietti , Marta Mantovani , Jacopo Francesco Imberti , Davide Antonio Mei , Niccolò Bonini , Giulio Francesco Romiti , Bernadette Corica , Igor Diemberger , Laurent Fauchier , Francisco Marín , Gheorghe-Andrei Dan , Tatjana S. Potpara , Gregory Y.H. Lip , Giuseppe Boriani","doi":"10.1016/j.rec.2025.07.005","DOIUrl":"10.1016/j.rec.2025.07.005","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Increased physical activity may improve outcomes in patients with atrial fibrillation (AF), but available data are limited. This study aimed to analyze the association between physical activity and major adverse outcomes in a large European AF cohort.</div></div><div><h3>Methods</h3><div>We used data from a prospective, observational, large-scale multicenter study of AF in European patients, involving 27 countries and 250 centers. Patients self-reported their physical activity levels during the preceding 2 years, categorized as none (physically inactive), occasional, regular, or intense. The primary outcome was a composite of major adverse cardiovascular (CV) events and all-cause mortality.</div></div><div><h3>Results</h3><div>A total of 9525 patients with AF were included (median age 71 years; 41% female). Overall, 43% reported being physically inactive. Among those who reported physical activity, 56.9% described it as occasional, 36.5% as regular, and 6.6% as intense. Inactive patients had a higher burden of both CV and non-CV comorbidities. Over a median follow-up of 728 days, 16.2% of the patients experienced the primary composite endpoint. Physical activity was independently associated with a lower risk of the primary endpoint (adjusted HR, 0.68; 95% CI, 0.59-0.76), with a progressively lower incidence as activity levels increased. Interaction analyses showed that the beneficial effect of physical activity was consistent among several subgroups, with no significant interactions.</div></div><div><h3>Conclusions</h3><div>Physical activity, even at low levels, was associated with a reduced incidence of CV events and all-cause mortality. These benefits appear to be independent of CV risk factors and comorbidities, highlighting the importance of incorporating physical activity into holistic AF management strategies.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"79 2","pages":"Pages 151-164"},"PeriodicalIF":4.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-13DOI: 10.1016/j.rec.2025.07.006
Jun Hao, Jingyang Wang, Rui Shi, Qi Wang, Xiaohua Cheng, Jiayu Feng, Yanmin Yang, Yuxiao Hu, Tao Chen, Kangyu Chen
Introduction and objectives: Resting heart rate is a readily available vital sign with important prognostic significance. However, traditional measures overlook both the magnitude and duration of elevated heart rate over time. This study assessed the association between cumulative resting heart rate load and adverse outcomes in patients with chronic heart failure (HF) in sinus rhythm.
Methods: Data from 5 randomized controlled trials (BEST, GUIDE-IT, HF-ACTION, RELAX, and TOPCAT) were analyzed. Cumulative heart rate load was calculated as the area under the curve (AUC) for heart rate ≥70 beats per minute (bpm), relative to the total AUC prior to outcomes. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiovascular death and hospitalization for HF. Cox proportional hazards regression models were used to examine associations with outcomes.
Results: A total of 5428 patients were included. Higher cumulative resting heart rate load was significantly associated with increased risk of MACE (hazard ratio [HR], 1.31; 95% CI, 1.24-1.38), cardiovascular death (HR, 1.17; 95% CI, 1.08-1.27), hospitalization for HF (HR, 1.34; 95% CI, 1.26-1.43), all-cause death (HR, 1.20; 95% CI, 1.12-1.29), and any hospitalization (HR, 1.20; 95% CI, 1.15-1.25). Cumulative resting heart rate load demonstrated superior predictive value for all outcomes compared with baseline heart rate, mean heart rate, heart rate standard deviation, and heart rate time in the target range with improvements in C-statistics, net reclassification improvement, and integrated discrimination improvement when added to base models.
Conclusions: Cumulative resting heart rate load provides stronger prognostic value for adverse outcomes in chronic HF. Incorporating this parameter into clinical practice may improve risk stratification and help identify high-risk patients who could benefit from intensive monitoring or therapeutic interventions.
{"title":"Cumulative resting heart rate load and cardiovascular risk in patients with heart failure in sinus rhythm.","authors":"Jun Hao, Jingyang Wang, Rui Shi, Qi Wang, Xiaohua Cheng, Jiayu Feng, Yanmin Yang, Yuxiao Hu, Tao Chen, Kangyu Chen","doi":"10.1016/j.rec.2025.07.006","DOIUrl":"10.1016/j.rec.2025.07.006","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Resting heart rate is a readily available vital sign with important prognostic significance. However, traditional measures overlook both the magnitude and duration of elevated heart rate over time. This study assessed the association between cumulative resting heart rate load and adverse outcomes in patients with chronic heart failure (HF) in sinus rhythm.</p><p><strong>Methods: </strong>Data from 5 randomized controlled trials (BEST, GUIDE-IT, HF-ACTION, RELAX, and TOPCAT) were analyzed. Cumulative heart rate load was calculated as the area under the curve (AUC) for heart rate ≥70 beats per minute (bpm), relative to the total AUC prior to outcomes. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiovascular death and hospitalization for HF. Cox proportional hazards regression models were used to examine associations with outcomes.</p><p><strong>Results: </strong>A total of 5428 patients were included. Higher cumulative resting heart rate load was significantly associated with increased risk of MACE (hazard ratio [HR], 1.31; 95% CI, 1.24-1.38), cardiovascular death (HR, 1.17; 95% CI, 1.08-1.27), hospitalization for HF (HR, 1.34; 95% CI, 1.26-1.43), all-cause death (HR, 1.20; 95% CI, 1.12-1.29), and any hospitalization (HR, 1.20; 95% CI, 1.15-1.25). Cumulative resting heart rate load demonstrated superior predictive value for all outcomes compared with baseline heart rate, mean heart rate, heart rate standard deviation, and heart rate time in the target range with improvements in C-statistics, net reclassification improvement, and integrated discrimination improvement when added to base models.</p><p><strong>Conclusions: </strong>Cumulative resting heart rate load provides stronger prognostic value for adverse outcomes in chronic HF. Incorporating this parameter into clinical practice may improve risk stratification and help identify high-risk patients who could benefit from intensive monitoring or therapeutic interventions.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-07DOI: 10.1016/j.rec.2025.07.004
Fernando Civeira , Estíbaliz Jarauta , Victoria Marco-Benedí , Ana M. Bea , Rocío Mateo-Gallego , Itziar Lamiquiz-Moneo , Irene Gracia-Rubio , Daniel Bello-Álvarez , Martín Laclaustra , María Teresa Tejedor , Salvador Olmos , Ana Cenarro
Introduction and objectives
The frequency, clinical characteristics and risk of atherosclerotic cardiovascular disease (ASCVD) of the different types of hypercholesterolemia are not well established. The primary and secondary objectives of this study were to determine the cause of hypercholesterolemia and whether the cause confers a different ASCVD prognosis.
Methods
The analysis included 3474 probands with primary hypercholesterolemia, of whom 3283 (94.8%) were followed up for 9.33 ± 5.8 years for ASCVD. Genetic analysis of familial hypercholesterolemia (FH) genes, polygenic risk score for hypercholesterolemia, and lipid concentrations, including lipoprotein(a), were used to classify hypercholesterolemia.
Results
The diagnoses were heterozygous FH, n = 400 (11.5%); hyperlipoproteinemia(a), n = 181 (5.2%); polygenic hypercholesterolemia, n = 434 (12.5%); hyperlipoproteinemia(a) plus polygenic hypercholesterolemia, n = 128 (3.7%); multifactorial, n = 1562 (45.0%); and idiopathic, n = 769 (22.1%). At baseline, low-density lipoprotein cholesterol levels were higher in heterozygous FH, and the prevalence of ASCVD was higher in hyperlipoproteinemia(a). Other clinical and biochemical characteristics did not differ among hypercholesterolemia subgroups. The survival rate was lower in participants with hyperlipoproteinemia(a) than in the other hypercholesterolemia groups (P = .001). Variables independently associated with ASCVD events during follow-up were age, male sex, the presence of ASCVD, diabetes or hypertension at baseline, current smoking, lipoprotein(a) concentration, and high-density lipoprotein cholesterol concentration, the latter being inversely associated with ASCVD events. Total mortality was independent of the type of hypercholesterolemia.
Conclusions
Genetic hypercholesterolemia has a worse prognosis for ASCVD than nongenetic hypercholesterolemia. Among individuals with genetic hypercholesterolemia, those with elevated lipoprotein(a) have the worst prognosis. Conventional lipid-lowering treatment for low-density lipoprotein cholesterol appears to be less effective in hypercholesterolemia due to hyperlipoproteinemia(a) than in other forms of hypercholesterolemia.
{"title":"Classification, prevalence and cardiovascular risk of different types of hypercholesterolemia","authors":"Fernando Civeira , Estíbaliz Jarauta , Victoria Marco-Benedí , Ana M. Bea , Rocío Mateo-Gallego , Itziar Lamiquiz-Moneo , Irene Gracia-Rubio , Daniel Bello-Álvarez , Martín Laclaustra , María Teresa Tejedor , Salvador Olmos , Ana Cenarro","doi":"10.1016/j.rec.2025.07.004","DOIUrl":"10.1016/j.rec.2025.07.004","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The frequency, clinical characteristics and risk of atherosclerotic cardiovascular disease (ASCVD) of the different types of hypercholesterolemia are not well established. The primary and secondary objectives of this study were to determine the cause of hypercholesterolemia and whether the cause confers a different ASCVD prognosis.</div></div><div><h3>Methods</h3><div>The analysis included 3474 probands with primary hypercholesterolemia, of whom 3283 (94.8%) were followed up for 9.33<!--> <!-->± 5.8 years for ASCVD. Genetic analysis of familial hypercholesterolemia (FH) genes, polygenic risk score for hypercholesterolemia, and lipid concentrations, including lipoprotein(a), were used to classify hypercholesterolemia.</div></div><div><h3>Results</h3><div>The diagnoses were heterozygous FH, n<!--> <!-->=<!--> <!-->400 (11.5%); hyperlipoproteinemia(a), n<!--> <!-->=<!--> <!-->181 (5.2%); polygenic hypercholesterolemia, n<!--> <!-->=<!--> <!-->434 (12.5%); hyperlipoproteinemia(a) plus polygenic hypercholesterolemia, n<!--> <!-->=<!--> <!-->128 (3.7%); multifactorial, n<!--> <!-->=<!--> <!-->1562 (45.0%); and idiopathic, n<!--> <!-->=<!--> <!-->769 (22.1%). At baseline, low-density lipoprotein cholesterol levels were higher in heterozygous FH, and the prevalence of ASCVD was higher in hyperlipoproteinemia(a). Other clinical and biochemical characteristics did not differ among hypercholesterolemia subgroups. The survival rate was lower in participants with hyperlipoproteinemia(a) than in the other hypercholesterolemia groups (<em>P</em> <!-->=<!--> <!-->.001). Variables independently associated with ASCVD events during follow-up were age, male sex, the presence of ASCVD, diabetes or hypertension at baseline, current smoking, lipoprotein(a) concentration, and high-density lipoprotein cholesterol concentration, the latter being inversely associated with ASCVD events. Total mortality was independent of the type of hypercholesterolemia.</div></div><div><h3>Conclusions</h3><div>Genetic hypercholesterolemia has a worse prognosis for ASCVD than nongenetic hypercholesterolemia. Among individuals with genetic hypercholesterolemia, those with elevated lipoprotein(a) have the worst prognosis. Conventional lipid-lowering treatment for low-density lipoprotein cholesterol appears to be less effective in hypercholesterolemia due to hyperlipoproteinemia(a) than in other forms of hypercholesterolemia.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"79 2","pages":"Pages 131-141"},"PeriodicalIF":4.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-25DOI: 10.1016/j.rec.2025.05.012
Jesús Díaz-Gutiérrez, María Del Carmen Aznar de la Riera, Ana Blanca Paloma Martínez-Pérez, Emilio Amigo-Otero, Fernando Rodríguez-Artalejo, Mercedes Sotos-Prieto, Antonio Gómez-Menchero, Ana López Suárez, Raúl López Aguilar, María Luisa Hidalgo, Ana Rodríguez Morales
{"title":"Mediterranean lifestyle for secondary prevention of cardiovascular disease: the MEDLIFE pilot study.","authors":"Jesús Díaz-Gutiérrez, María Del Carmen Aznar de la Riera, Ana Blanca Paloma Martínez-Pérez, Emilio Amigo-Otero, Fernando Rodríguez-Artalejo, Mercedes Sotos-Prieto, Antonio Gómez-Menchero, Ana López Suárez, Raúl López Aguilar, María Luisa Hidalgo, Ana Rodríguez Morales","doi":"10.1016/j.rec.2025.05.012","DOIUrl":"10.1016/j.rec.2025.05.012","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 10.1016/j.rec.2025.06.008
Alejandro Gullón de la Roza , María Salgado Barquinero , María Fernández García , Beatriz Nieves Ureña , Fernando López Iglesias , María Martín Fernández
{"title":"Myocarditis secondary to small vessel vasculitis: an uncommon etiology","authors":"Alejandro Gullón de la Roza , María Salgado Barquinero , María Fernández García , Beatriz Nieves Ureña , Fernando López Iglesias , María Martín Fernández","doi":"10.1016/j.rec.2025.06.008","DOIUrl":"10.1016/j.rec.2025.06.008","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 12","pages":"Pages 1115-1117"},"PeriodicalIF":4.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-21DOI: 10.1016/j.rec.2025.07.002
Katarzyna Gendera , Stanimir Georgiev , Andreas Eicken , Andrea Amici , Alfred Hager , Maria von Stumm , Daniel Dilber , Peter Ewert , Pinar Bambul Heck
Introduction and objectives
Stent implantation has become the gold standard for the treatment of native coarctation of the aorta (CoA) and recurrent CoA in adolescents and adults. In smaller children, however, stent implantation remains technically challenging due to anatomical constraints and growth considerations. Furthermore, data on the optimal treatment strategy in this age group are still limited. This study retrospectively analyzed clinical outcomes in young children treated with stent implantation for recurrent aortic arch stenosis.
Methods
A total of 101 patients (63 male; 62%) with a body weight of less than 15 kg were treated with endovascular stent implantation for restenosis of the reconstructed aortic arch (n = 94; 93%) or native CoA (n = 7; 7%). The median age at the time of stent implantation was 4.8 months (IQR, 3.2-9.6 months) with a median body weight of 5.9 kg (IQR, 4.7-8.4 kg). The median follow-up period was 46.4 months (IQR, 11.0-76.6 months).
Results
All procedures were successful, and no serious complications occurred. The peak-to-peak gradient decreased significantly from a median of 32.5 mmHg (IQR, 17.3-46.0 mmHg) to 0.0 mmHg (IQR, 0.0-2.5 mmHg; P < .005). The diameter of the narrow segment increased from a median of 3.0 mm (IQR, 2.0-4.0 mm) to 6.9 mm (IQR, 6.0-8.0 mm; P < .005). During follow-up, none of the patients required reoperation.
Conclusions
Stent implantation is a safe and feasible treatment option in patients with restenosis after complex aortic arch reconstruction or native CoA in whom surgical treatment would pose an elevated risk of complications. However, repeated dilatations and, ultimately, intentional stent fracture are required during follow-up.
{"title":"Stent implantation for recurrent stenosis after aortic arch repair in small children: short- and mid-term results without reoperations","authors":"Katarzyna Gendera , Stanimir Georgiev , Andreas Eicken , Andrea Amici , Alfred Hager , Maria von Stumm , Daniel Dilber , Peter Ewert , Pinar Bambul Heck","doi":"10.1016/j.rec.2025.07.002","DOIUrl":"10.1016/j.rec.2025.07.002","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Stent implantation has become the gold standard for the treatment of native coarctation of the aorta (CoA) and recurrent CoA in adolescents and adults. In smaller children, however, stent implantation remains technically challenging due to anatomical constraints and growth considerations. Furthermore, data on the optimal treatment strategy in this age group are still limited. This study retrospectively analyzed clinical outcomes in young children treated with stent implantation for recurrent aortic arch stenosis.</div></div><div><h3>Methods</h3><div>A total of 101 patients (63 male; 62%) with a body weight of less than 15<!--> <!-->kg were treated with endovascular stent implantation for restenosis of the reconstructed aortic arch (n<!--> <!-->=<!--> <!-->94; 93%) or native CoA (n<!--> <!-->=<!--> <!-->7; 7%). The median age at the time of stent implantation was 4.8 months (IQR, 3.2-9.6 months) with a median body weight of 5.9<!--> <!-->kg (IQR, 4.7-8.4<!--> <!-->kg). The median follow-up period was 46.4 months (IQR, 11.0-76.6 months).</div></div><div><h3>Results</h3><div>All procedures were successful, and no serious complications occurred. The peak-to-peak gradient decreased significantly from a median of 32.5<!--> <!-->mmHg (IQR, 17.3-46.0<!--> <!-->mmHg) to 0.0<!--> <!-->mmHg (IQR, 0.0-2.5<!--> <!-->mmHg; <em>P</em> <!--><<!--> <!-->.005). The diameter of the narrow segment increased from a median of 3.0<!--> <!-->mm (IQR, 2.0-4.0<!--> <!-->mm) to 6.9<!--> <!-->mm (IQR, 6.0-8.0<!--> <!-->mm; <em>P</em> <!--><<!--> <!-->.005). During follow-up, none of the patients required reoperation.</div></div><div><h3>Conclusions</h3><div>Stent implantation is a safe and feasible treatment option in patients with restenosis after complex aortic arch reconstruction or native CoA in whom surgical treatment would pose an elevated risk of complications. However, repeated dilatations and, ultimately, intentional stent fracture are required during follow-up.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"79 2","pages":"Pages 142-150"},"PeriodicalIF":4.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-21DOI: 10.1016/j.rec.2025.07.003
Eun-Seok Shin , Sunwon Kim , Dong Oh Kang , Bitna Kim , Ae-Young Her
Introduction and objectives
There are limited data on drug-coated balloon (DCB) treatment for de novo diffuse coronary artery disease (CAD). This study aimed to evaluate the clinical impact of DCB-based percutaneous coronary intervention (PCI) in patients with de novo diffuse long CAD.
Methods
We retrospectively included 623 patients with single de novo diffuse CAD (≥ 30 mm). These patients underwent PCI exclusively for the target lesion and were successfully treated with DCB-based PCI. They were compared with 623 propensity-matched patients who underwent conventional PCI with second-generation drug-eluting stents (DES) for diffuse CAD (DES-only group). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years.
Results
In the DCB-based group, 73.7% of patients were treated with DCB alone. The MACE rate was significantly lower in the DCB-based group than in the DES-only group (4.6% vs 14.6%; HR, 0.29; 95%CI, 0.18-0.47; P < .001). Rates of target vessel revascularization (3.1% vs 9.7%; P < .001) and major bleeding events (0.8% vs 2.7%; P = .008) were also lower with DCB-based PCI than with DES-only PCI. In a multivariable model, DCB-based PCI was independently associated with a lower risk of 2-year MACE, target vessel revascularization, and major bleeding.
Conclusions
In patients with de novo diffuse CAD, DCB-based PCI was associated with a significant reduction in MACE compared with DES-only PCI.
前言和目的：药物包被球囊（DCB）治疗新发弥漫性冠状动脉疾病（CAD）的数据有限。本研究旨在评估基于dbc的经皮冠状动脉介入治疗（PCI）对新发弥漫性长时间冠心病患者的临床影响。方法：我们回顾性纳入623例新发弥漫性CAD（≥30 mm）患者。这些患者接受了专门针对目标病变的PCI，并成功地接受了基于dbc的PCI治疗。他们与623名倾向匹配的接受常规PCI +第二代药物洗脱支架（DES）治疗弥漫性CAD的患者（DES组）进行比较。主要终点是主要心血管不良事件（MACE），定义为心脏性死亡、心肌梗死、支架或靶病变血栓形成、靶血管重建术和2年大出血的复合。结果：在以DCB为基础的组中，73.7%的患者单用DCB治疗。dcb组的MACE率明显低于des组(4.6% vs 14.6%；风险比：0.29；95%置信区间：0.18-0.47；P < 0.001)。靶血管重建率(3.1% vs 9.7%；P < 0.001)和大出血事件(0.8% vs 2.7%；P = 0.008)基于dbc的PCI也低于仅des的PCI。在多变量模型中，基于dbc的PCI与2年MACE、靶血管重建术和大出血的风险较低独立相关。结论：在新发弥漫性CAD患者中，与仅des的PCI相比，基于dbc的PCI与MACE的显著降低相关。
{"title":"Drug-coated balloon-based versus drug-eluting stent-only treatment for single de novo diffuse coronary lesions","authors":"Eun-Seok Shin , Sunwon Kim , Dong Oh Kang , Bitna Kim , Ae-Young Her","doi":"10.1016/j.rec.2025.07.003","DOIUrl":"10.1016/j.rec.2025.07.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>There are limited data on drug-coated balloon (DCB) treatment for de novo diffuse coronary artery disease (CAD). This study aimed to evaluate the clinical impact of DCB-based percutaneous coronary intervention (PCI) in patients with de novo diffuse long CAD.</div></div><div><h3>Methods</h3><div>We retrospectively included 623 patients with single de novo diffuse CAD (≥ 30<!--> <!-->mm). These patients underwent PCI exclusively for the target lesion and were successfully treated with DCB-based PCI. They were compared with 623 propensity-matched patients who underwent conventional PCI with second-generation drug-eluting stents (DES) for diffuse CAD (DES-only group). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years.</div></div><div><h3>Results</h3><div>In the DCB-based group, 73.7% of patients were treated with DCB alone. The MACE rate was significantly lower in the DCB-based group than in the DES-only group (4.6% vs 14.6%; HR, 0.29; 95%CI, 0.18-0.47; <em>P</em> <!--><<!--> <!-->.001). Rates of target vessel revascularization (3.1% vs 9.7%; <em>P</em> <!--><<!--> <!-->.001) and major bleeding events (0.8% vs 2.7%; <em>P</em> <!-->=<!--> <!-->.008) were also lower with DCB-based PCI than with DES-only PCI. In a multivariable model, DCB-based PCI was independently associated with a lower risk of 2-year MACE, target vessel revascularization, and major bleeding.</div></div><div><h3>Conclusions</h3><div>In patients with de novo diffuse CAD, DCB-based PCI was associated with a significant reduction in MACE compared with DES-only PCI.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"79 2","pages":"Pages 108-116"},"PeriodicalIF":4.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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