Acta Cardiologica Sinica最新文献

Background: The obesity paradox refers to lower mortality rates among overweight or obese individuals within certain populations. However, whether this paradox is applicable to patients undergoing percutaneous coronary intervention (PCI) remains unclear.

Methods: A total of 5,427 patients with coronary artery disease (CAD) who underwent successful PCI between 2005 and 2015 were enrolled. The association between body mass index (BMI) and future adverse cardiovascular events post PCI was analyzed. The study endpoints encompassed total cardiovascular (CV) events, including cardiac death, nonfatal myocardial infarction (MI), ischemic stroke, and hospitalization for congestive heart failure (CHF).

Results: Over an average follow-up period of 65.1 ± 32.1 months, 942 patients (17.4%) had CV events, including 200 CV deaths (3.7%), 294 acute MIs (5.4%), 111 ischemic strokes (2.0%), 469 CHF hospitalizations (8.6%), and 1,098 revascularizations (20.2%). A J-shaped relationship between BMI and future adverse events was observed, in which individuals with a BMI of 25.0-29.9 kg/m² had significantly lower risks of total CV events [hazard ratio (HR) = 0.84, 95% confidence interval (CI) = 0.72-0.98], major adverse cardiovascular events (HR = 0.76, 95% CI = 0.63-0.93), acute MI (HR = 0.76, 95% CI = 0.58-1.00), and ischemic stroke (HR = 0.61, 95% CI = 0.39-0.95), compared to those with a BMI of 22.0-24.9 kg/m².

Conclusions: We found a J-shaped relationship between baseline BMI and future adverse events in CAD patients undergoing PCI. Overweight individuals (BMI 25.0-29.9 kg/m²) had the lowest future risk of total CV events compared to those with a normal BMI (22.0-24.9 kg/m²).

Aims: This study aims to verify the feasibility and safety of percutaneous coronary intervention (PCI) after a distal transradial approach (dTRA) with radial artery occlusion (RAO) recanalization.

Methods: Between July 2018 and January 2022, 30 patients underwent PCI following attempted RAO recanalization via dTRA. Among these cases, the target radial arteries could not be recanalized in five patients, necessitating alternative vascular access. The remaining 25 patients with successful RAO recanalization were divided into a standard group (n = 19) and tough group (n = 6), the latter requiring more than 10 minutes and complex techniques and devices for recanalization.

Results: The procedural success rate was 96.7%, with vascular access-site complications occurring in 20% of the cases, including five perforations easily managed with prolonged balloon inflation and one pseudoaneurysm without flow limitation. In the tough group, no significant increase in procedural complications, access-site vascular complications, or total major adverse cardiac and cerebrovascular events was observed. However, Doppler ultrasound one month later for the recanalized radial artery revealed a significantly higher rate of severe stenosis and re-occlusion at 100% compared to 10% in the standard group, as supported by receiver operating characteristic curve analysis.

Conclusions: The feasibility and safety of PCI following RAO recanalization via dTRA were acceptable. We propose a 10-minute threshold to differentiate between standard and tough groups during RAO recanalization. Given the uncertainty of long-term patency in recanalized RAs, the primary goal in tough cases is to ensure the guide catheter reaches the ascending aorta for subsequent PCI.

Background: Atrial fibrillation (AF) increases the risks of stroke and mortality. It remains unclear whether rhythm control reduces the risk of stroke in patients with AF concomitant with hypertrophic cardiomyopathy (HCM).

Methods: We identified AF patients with HCM who were ≥ 18 years old in the Taiwan National Health Insurance Database. Patients using antiarrhythmic medications for ≥ 30 defined daily doses (DDDs) or receiving catheter ablation for AF constituted the rhythm control group. Patients using rate control medications for ≥ 30 DDDs constituted the rate control group. A multivariable Cox regression model was used to evaluate the hazard ratio (HR) for adverse cardiovascular events.

Results: We enrolled a total of 178 patients with both AF and HCM without pre-existing cardiovascular diseases. Among them, 99 were in the rhythm control group and 79 were in the rate control group. After a follow-up period of 6.47 ± 0.98 years, the rhythm control group had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.031) after adjusting for covariates including use of antithrombotic agents. After excluding patients receiving catheter ablation, the rhythm control group still had a lower risk of stroke than the rate control group (adjusted HR: 0.380, p = 0.037).

Conclusions: In patients with AF and HCM, rhythm control with mainly pharmacological treatment better prevented stroke than rate control in long-term follow-up. The beneficial effect of lowering stroke risk through rhythm control was independent of oral anticoagulant use.

Background: The systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are novel inflammation-related markers calculated based on peripheral blood count. Data on biomarkers for the prognosis of peripheral artery disease (PAD) are limited. We aimed to evaluate the impact of these four inflammation-related biomarkers on mid-term restenosis and mortality rates in PAD patients.

Methods: This retrospective single-center study was conducted at a tertiary hospital between March 2020 and May 2023. Patients admitted to our catheterization laboratory for percutaneous coronary intervention for PAD were enrolled. The primary endpoint was all-cause mortality, and the secondary endpoint was restenosis.

Results: A total of 418 participants were enrolled, including 211 in the study group and 207 in the control group. The average follow-up period was 20.80 ± 10.11 months. During the follow-up period, 39 patients (18.5%) died and restenosis occurred in 37 patients (17.5%). The mortality rate was significantly higher in the patients with high SII, SIRI, NLR, and PLR (p = 0.001, p = 0.001, p = 0.001, and p = 0.001, respectively). No significant correlations were found between SII, SIRI, NLR, PLR, and restenosis (all p > 0.05). In multivariate logistic regression analysis, only NLR was found to be an independent risk factor for mortality [(odds ratio) 6.91, 95% confidence interval: 3.18-14.99, p = 0.001].

Conclusions: The SII, SIRI, NLR, and PLR were higher in non-survivors, and NLR was independently associated with mortality in patients with PAD.

Background: Dual antiplatelet therapy (DAPT) is the standard treatment for acute myocardial infarction (MI). This study aimed to investigate the use of DAPT and de-escalation after discharge in real-world practice among patients with acute MI undergoing percutaneous coronary intervention (PCI) in Taiwan.

Methods: Using the Taiwan National Health Insurance Research Database, we included patients who received PCI for acute MI and survived to discharge with DAPT from 2011 to 2021. The choice of different P2Y12 inhibitors at discharge and de-escalation therapy after discharge were analyzed.

Results: Overall, 58989 patients (mean age 61.9 ± 13.2 years, male 81.4%) were included. The initial use of aspirin plus ticagrelor (A + T) increased from 4.8% in 2013 to 73.2% in 2021 (p < 0.01). Switch to de-escalation therapy occurred in 52.7% of the A + T users at 9 months follow-up. Aspirin plus clopidogrel (A + C) and ticagrelor monotherapy were the most commonly used de-escalation therapies in the first 6 months. Multivariable logistic regression analysis demonstrated that older patients and those with non-ST-segment elevation MI, multi-vessel PCI, baseline bleeding risk and bleeding events during follow-up were more likely to receive ticagrelor monotherapy than A + C.

Conclusions: A + T has become the major initial DAPT for patients with acute MI undergoing PCI in Taiwan, but de-escalation is not uncommon after discharge. Ticagrelor monotherapy was more likely to be prescribed than A + C in those with multi-vessel PCI or bleeding concern.

This 2025 updated consensus outlines the diagnostic strategy for transthyretin amyloid cardiomyopathy (ATTR-CM). Given that ATTR-CM is a significant contributor to heart failure, this article emphasizes the importance of making an early and precise diagnosis, particularly as new therapeutic options become available. Highlighting the critical importance of an early and accurate diagnosis, particularly in light of emerging therapeutic modalities, this consensus underscores the central role of ^99mTc-pyrophosphate (PYP) scintigraphy as a non-invasive diagnostic tool. The consensus calls for the adoption of standardized imaging protocols and interpretation criteria to ensure consistency and reliability across diverse clinical settings. The integration of qualitative and quantitative imaging techniques within a structured diagnostic framework places particular focus on the use of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging to enhance diagnostic precision by minimizing blood pool activity and eliminating overlapping interference. Three-hour imaging is considered to be critical for accurate evaluations and to reduce false-positive findings, and it is recommended for its superior diagnostic accuracy. Moreover, quantitative assessments are also considered to be essential for evaluating myocardial amyloid deposition. This updated consensus provides comprehensive guidelines for clinicians, with the aim of optimizing patient outcomes through precise diagnosis and effective management of ATTR-CM. The consensus concludes by advocating for continued research and refinement of imaging methodologies, particularly to enhance the clinical applicability of ^99mTc-PYP scintigraphy and other future developments in nuclear molecular imaging.

Transthoracic echocardiography plays a crucial role in clinical diagnosis and is increasingly being used around the world. Comprehensive echocardiographic examinations require accurate measurements and the operators to have excellent technical skills. Despite the availability of several published echocardiographic guidelines, the absence of recommended operational manuals in daily practice has resulted in significant variation in the content of echocardiography reports across different medical institutions. This variability has created communication barriers between medical institutions and also hampered the development of a national echocardiography database in Taiwan. Balancing quality and efficiency is a critical concern in echocardiography, and most published guidelines for echocardiography primarily focus on disease categorization. In the current document, we focus on information about the scanning sequence, including scanning techniques, common pitfalls, simple disease interpretation, and the recommended intensity. Based on a growing body of research, we particularly emphasize right-sided imaging and measurement information. We also discuss equipment settings, which have often been overlooked but are essential to obtaining good imaging and accurate measurements. Our recommendations could enhance clinicians' and sonographers' understanding of the core aspects of echocardiography and were developed with consideration of the health-care payment system in Taiwan. Implementing our recommendations may subsequently enable the establishment of a national echocardiography database in Taiwan.

Background: Prompt primary percutaneous coronary intervention (pPCI) is crucial for the prognosis and reduction of myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients. The Coronavirus Disease 2019 (COVID-19) pandemic had multifaceted impacts on healthcare. This study assessed the effects of the pandemic on pPCI procedures and clinical outcomes in emergency STEMI patients.

Methods: This retrospective, single-center study analyzed STEMI patients who underwent pPCI from February 2019 to January 2022. The COVID-19 pandemic was categorized into three periods: pre-COVID-19 (Period-I), early-pandemic (Period-II), and epidemic (Period-III). The impacts on Door-to-Device time, its segments, and clinical outcomes were analyzed using Statistical Package for the Social Sciences.

Results: A total of 404 STEMI patients were included, with a reduced number in Period-III. Compared to Period-I, the time intervals of Door-to-electrocardiogram (ECG), ECG-to-Cardiac Catheterization Laboratory Activation (CCLA), and CCLA-to-Cardiac Catheterization Laboratory Door in Period III were extended by 0.62 minutes (p = 0.006), 3.30 minutes (p = 0.009), and 9.65 minutes (p < 0.001), respectively. In contrast, the Angio-to-Device time was shorter in Period- II and III by 2.60 and 4.08 minutes (p < 0.001), respectively. Overall Door-to-Device time increased by 10.06 minutes (p < 0.001) in Period-III but decreased by 3.67 minutes in Period-II (p = 0.017). The odds of achieving a Door-to-Device time ≤ 90 minutes decreased by 70% in Period-III (p = 0.002). Clinical outcomes, including intensive care unit stay, hospital stay, in-hospital mortality, and 30-day readmission rate, remained stable across periods.

Conclusions: The COVID-19 pandemic had various effects on different segments of the Door-to-Device procedure, and they were influenced by the complex interplay between infection control measures and clinical workflow. The stability of clinical outcomes reflects the resilience and effective adaptations of the healthcare system during the pandemic.