Revista española de cardiología (English ed.)最新文献

Introduction and objectives: Significant secondary tricuspid regurgitation (STR) is associated with poor prognosis, but its heterogeneity makes predicting patient outcomes challenging. Our objective was to identify STR prognostic phenogroups.

Methods: We analyzed 758 patients with moderate-to-severe STR: 558 (74 ± 14 years, 55% women) in the derivation cohort and 200 (73 ± 12 years, 60% women) in the external validation cohort. The primary endpoint was a composite of heart failure hospitalization and all-cause mortality.

Results: We identified 3 phenogroups. The low-risk phenogroup (2-year event-free survival 80%, 95%CI, 74%-87%) had moderate STR, preserved right ventricular (RV) size and function, and a moderately dilated but normally functioning right atrium. The intermediate-risk phenogroup (HR, 2.20; 95%CI, 1.44-3.37; P < .001) included older patients with severe STR, and a mildly dilated but uncoupled RV. The high-risk phenogroup (HR, 4.67; 95%CI, 3.20-6.82; P < .001) included younger patients with massive-to-torrential tricuspid regurgitation, as well as severely dilated and dysfunctional RV and right atrium. Multivariable analysis confirmed the clustering as independently associated with the composite endpoint (HR, 1.40; 95%CI, 1.13-1.70; P = .002). A supervised machine learning model, developed to assist clinicians in assigning patients to the 3 phenogroups, demonstrated excellent performance both in the derivation cohort (accuracy = 0.91, precision = 0.91, recall = 0.91, and F1 score = 0.91) and in the validation cohort (accuracy = 0.80, precision = 0.78, recall = 0.78, and F1 score = 0.77).

Conclusions: The unsupervised cluster analysis identified 3 risk phenogroups, which could assist clinicians in developing more personalized treatment and follow-up strategies for STR patients.

Introduction and objectives: Long-term data after stenting of the left main coronary artery (LMCA) are scarce, especially regarding new-generation drug-eluting stents (DES). This analysis aimed to describe the 10-year clinical outcomes of patients who underwent percutaneous coronary intervention with different DES generations for LMCA disease.

Methods: Individual patient data from the randomized controlled ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials were pooled and 10-year clinical follow-up was obtained. The Kaplan-Meier method was used to calculate event rates. The main endpoints of interest for this analysis were all-cause mortality, myocardial infarction, target lesion revascularization and definite stent thrombosis.

Results: A total of 1257 patients were included in this analysis, of which 650 patients were treated with new-generation DES and 607 with early-generation DES. At 10 years, the mortality rate was more than 40% in both groups. After statistical adjustment, 10-year mortality was significantly reduced in patients treated with new-generation DES compared with those treated with early-generation DES (HR_adj, 0.78; 95%CI, 0.62-0.97). After 10 years, the risk of myocardial infarction (HR_adj, 0.43; 95%CI, 0.23-0.80), target lesion revascularization (HR_adj, 0.66; 95%CI, 0.49-0.89), and definite stent thrombosis (HR_adj, 0.13, 95%CI, 0.04-0.49) was significantly reduced by new-generation DES compared with early-generation DES.

Conclusions: Patients undergoing percutaneous coronary intervention for LMCA disease have high 10-year mortality regardless of DES generation. The use of new-generation DES in patients with LMCA disease is associated with improved long-term clinical outcomes compared with early-generation DES.

Introduction and objectives: Arrhythmias such as atrial fibrillation and atrial flutter (AF/AFl) complicate the management of patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The aim of this study was to analyze the prognostic impact of AF/AFl in this clinical setting.

Methods: The IMPACT-TIMING-GO is a prospective, multicenter registry that enrolled patients with NSTEACS undergoing invasive management. In this subanalysis, patients were categorized based on the presence of AF/AFl (either pre-existing or occurring during admission). Clinical management and complications were assessed both during hospitalization (using a composite endpoint of death, renal failure, ventricular arrhythmias, delirium, new infarction, mechanical complications, and major bleeding) and after 1 year of follow-up (using a composite endpoint of death, cardiovascular admissions, and major bleeding).

Results: A total of 1020 patients (mean age, 66.8±12.7 years; 23.5% women) were included. Of these, 79 (7.7%) had prior AF/AFl, and 37 (3.6%) developed de novo AF/AFl during admission. Patients with AF/AFl were older and had a higher comorbidity burden, with de novo AF/AFl being associated with greater clinical severity. After multivariate adjustment, only de novo AF/AFl, and not previous AF/AFl, was independently associated with the composite endpoint of in-hospital complications (OR, 5.12; 95%CI, 2.30-11.43; P <.001 vs OR, 1.70, 95%CI, 0.91-3.58; P=.166) and adverse events at 1 year (HR, 1.95; 95%CI, 1.02-3.76; P=.045 vs HR, 1.02, 95%CI, 0.55-5.86; P=.957).

Conclusions: In patients with NSTEACS, de novo AF/AFl is independently associated with higher rates of both in-hospital and follow-up complications.