Pub Date : 2026-02-01DOI: 10.1016/j.jacasi.2025.10.015
Yasuhiro Hamatani MD, PhD , Maria A. Pabon MD , Xiaowen Wang MD, MPH
{"title":"Sex Differences in the Growing Challenge of Ischemic Heart Disease in South Asia","authors":"Yasuhiro Hamatani MD, PhD , Maria A. Pabon MD , Xiaowen Wang MD, MPH","doi":"10.1016/j.jacasi.2025.10.015","DOIUrl":"10.1016/j.jacasi.2025.10.015","url":null,"abstract":"","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"6 2","pages":"Pages 175-177"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jacasi.2025.12.008
Zhifeng Yao MD, PhD, Meng Ji MD, PhD, Yizhe Wu MD, PhD, Li Shen MD, PhD, Juying Qian MD, PhD, Junbo Ge MD, PhD
This study assessed the feasibility and safety of ultrasound renal denervation (uRDN) targeting both main and branch renal arteries to treat uncontrolled hypertension. A circumferential uRDN system was evaluated in a porcine model (n = 6) and a first-in-human study (n = 5). Endpoints included the incidence of device-related adverse events and changes in blood pressure. Preclinical studies revealed a favorable safety profile and >97% reduction in renal norepinephrine levels. In the human study, all procedures were technically successful without device-related adverse events. At 2 and 6 months, 24-hour ambulatory systolic/diastolic blood pressure decreased by 8.8 (95% CI: 0.98-16.62)/4.6 (95% CI: −1.83 to 11.03) mm Hg and 16 (95% CI: 1.18-30.82)/8 (95% CI: 0.76-15.24) mm Hg , respectively. These preliminary findings support the feasibility and safety of this circumferential uRDN approach for uncontrolled hypertension. (A Prospective Feasibility Trial Investigating the Use of Hantong Medical uRDN System in Patients With Uncontrolled Hypertension (Hammer HTN; ChiCTR2400093088)
{"title":"Circumferential Ultrasonic Renal Denervation Targeting Main Renal Arteries and Branches","authors":"Zhifeng Yao MD, PhD, Meng Ji MD, PhD, Yizhe Wu MD, PhD, Li Shen MD, PhD, Juying Qian MD, PhD, Junbo Ge MD, PhD","doi":"10.1016/j.jacasi.2025.12.008","DOIUrl":"10.1016/j.jacasi.2025.12.008","url":null,"abstract":"<div><div>This study assessed the feasibility and safety of ultrasound renal denervation (uRDN) targeting both main and branch renal arteries to treat uncontrolled hypertension. A circumferential uRDN system was evaluated in a porcine model (n = 6) and a first-in-human study (n = 5). Endpoints included the incidence of device-related adverse events and changes in blood pressure. Preclinical studies revealed a favorable safety profile and >97% reduction in renal norepinephrine levels. In the human study, all procedures were technically successful without device-related adverse events. At 2 and 6 months, 24-hour ambulatory systolic/diastolic blood pressure decreased by 8.8 (95% CI: 0.98-16.62)/4.6 (95% CI: −1.83 to 11.03) mm Hg and 16 (95% CI: 1.18-30.82)/8 (95% CI: 0.76-15.24) mm Hg , respectively. These preliminary findings support the feasibility and safety of this circumferential uRDN approach for uncontrolled hypertension. (A Prospective Feasibility Trial Investigating the Use of Hantong Medical uRDN System in Patients With Uncontrolled Hypertension (Hammer HTN; <span><span>ChiCTR2400093088</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"6 2","pages":"Pages 263-268"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jacasi.2025.12.004
Jung-Kyu Han MD, PhD , Haena Lee MS , Doyeon Hwang MD , Jeehoon Kang MD , Han-Mo Yang MD, PhD , Kyung Woo Park MD, PhD , Hyun-Jae Kang MD, PhD , Bon-Kwon Koo MD, PhD
{"title":"Rebound Phenomenon of Platelet Reactivity After Cessation of Long-Term Clopidogrel Therapy","authors":"Jung-Kyu Han MD, PhD , Haena Lee MS , Doyeon Hwang MD , Jeehoon Kang MD , Han-Mo Yang MD, PhD , Kyung Woo Park MD, PhD , Hyun-Jae Kang MD, PhD , Bon-Kwon Koo MD, PhD","doi":"10.1016/j.jacasi.2025.12.004","DOIUrl":"10.1016/j.jacasi.2025.12.004","url":null,"abstract":"","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"6 2","pages":"Pages 249-252"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jacasi.2025.08.015
Chenguang Li MD , Daixin Ding PhD , Zhiqing Wang MD, PhD , Yong He MD , Yong Dong MD , Junqing Yang MD , Zheng Shen MD , Defeng Pan MD , William Wijns MD, PhD , Junbo Ge MD , Shengxian Tu PhD
Background
Incremental information on coronary physiology and plaque vulnerability may improve risk stratification beyond anatomy. Murray law–based quantitative flow ratio (μFR) and radial wall strain (RWS) are angiography-derived indices for assessing coronary physiology and plaque vulnerability, but their impact on revascularization decisions remains unclear.
Objectives
The authors aimed to evaluate the impact of incremental availability of μFR and RWS on revascularization decisions.
Methods
A web-based survey was conducted, comprising 25 angiographically intermediate lesions. Data from μFR, RWS, and optical coherence tomography (OCT) were stepwisely available to participating cardiologists to make revascularization decisions (medical therapy alone or revascularization) for each lesion: Decision I was made based on angiography and clinical data, Decision II was made after μFR was disclosed, Decision III followed after RWS disclosure, and Decision IV followed after OCT disclosure.
Results
A total of 87 interventional cardiologists from 30 Chinese clinical centers provided 1,975 lesion-based decision sets. Following stepwise data disclosure, revascularization decisions remained unchanged in 1,013 (51.3%) decision sets. From Decision I to Decision II, 416 (21.1%) treatment recommendations changed, with 322 shifting from revascularization to medical therapy. From Decision II to Decision III, 315 (15.9%) recommendations changed, with 223 from medical therapy to revascularization. From Decision III to Decision IV, 564 (28.6%) recommendations changed, with 526 from medical therapy to revascularization. If decisions were strictly based on OCT-derived lipid-to-cap ratio, a validated quantification of plaque vulnerability, only 317 (16.1%) decisions would change from Decision III to Decision IV.
Conclusions
Revascularization decisions for intermediate lesions changed significantly with sequential diagnostic data. Adding μFR to angiography decreased revascularization rates. Adding plaque vulnerability assessment significantly increased revascularization rates.
{"title":"Stepwise Assessment of Computational Coronary Physiology and Plaque Vulnerability","authors":"Chenguang Li MD , Daixin Ding PhD , Zhiqing Wang MD, PhD , Yong He MD , Yong Dong MD , Junqing Yang MD , Zheng Shen MD , Defeng Pan MD , William Wijns MD, PhD , Junbo Ge MD , Shengxian Tu PhD","doi":"10.1016/j.jacasi.2025.08.015","DOIUrl":"10.1016/j.jacasi.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Incremental information on coronary physiology and plaque vulnerability may improve risk stratification beyond anatomy. Murray law–based quantitative flow ratio (μFR) and radial wall strain (RWS) are angiography-derived indices for assessing coronary physiology and plaque vulnerability, but their impact on revascularization decisions remains unclear.</div></div><div><h3>Objectives</h3><div>The authors aimed to evaluate the impact of incremental availability of μFR and RWS on revascularization decisions.</div></div><div><h3>Methods</h3><div>A web-based survey was conducted, comprising 25 angiographically intermediate lesions. Data from μFR, RWS, and optical coherence tomography (OCT) were stepwisely available to participating cardiologists to make revascularization decisions (medical therapy alone or revascularization) for each lesion: Decision I was made based on angiography and clinical data, Decision II was made after μFR was disclosed, Decision III followed after RWS disclosure, and Decision IV followed after OCT disclosure.</div></div><div><h3>Results</h3><div>A total of 87 interventional cardiologists from 30 Chinese clinical centers provided 1,975 lesion-based decision sets. Following stepwise data disclosure, revascularization decisions remained unchanged in 1,013 (51.3%) decision sets. From Decision I to Decision II, 416 (21.1%) treatment recommendations changed, with 322 shifting from revascularization to medical therapy. From Decision II to Decision III, 315 (15.9%) recommendations changed, with 223 from medical therapy to revascularization. From Decision III to Decision IV, 564 (28.6%) recommendations changed, with 526 from medical therapy to revascularization. If decisions were strictly based on OCT-derived lipid-to-cap ratio, a validated quantification of plaque vulnerability, only 317 (16.1%) decisions would change from Decision III to Decision IV.</div></div><div><h3>Conclusions</h3><div>Revascularization decisions for intermediate lesions changed significantly with sequential diagnostic data. Adding μFR to angiography decreased revascularization rates. Adding plaque vulnerability assessment significantly increased revascularization rates.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"6 2","pages":"Pages 144-157"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Safety of proton pump inhibitors (PPIs) in patients undergoing percutaneous coronary intervention (PCI) with aspirin-free P2Y12 inhibitor monotherapy was unknown.
Objectives
The authors aimed to evaluate effects of PPIs in patients undergoing PCI with P2Y12 inhibitor monotherapy.
Methods
We compared outcomes between patients with and without PPI prescription in the STOPDAPT-3 trial enrolling patients undergoing PCI stratified by the no-aspirin (1-month prasugrel monotherapy followed by clopidogrel monotherapy: n = 2,909 [acute coronary syndrome: n = 2,170, high bleeding risk: n = 1,580]) and the aspirin (1-month dual antiplatelet therapy followed by aspirin monotherapy: n = 2,914 [acute coronary syndrome: n = 2,171, high bleeding risk: n = 1,566]) strategies at 1 year.
Results
PPIs were prescribed in 2,418 patients (83.1%) with the no-aspirin strategy, and in 2,695 patients (92.5%) with the aspirin strategy. In the propensity score matched cohort (no-aspirin strategy: n = 902 and aspirin strategy: n = 376), a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke more often occurred in the PPI group than in the no-PPI group with the no-aspirin strategy (7.1% vs 2.4%, P = 0.002), but not with the aspirin strategy (6.9% vs 7.4%, P = 0.817). Death also more often occurred in the PPI group than in the no-PPI group with the no-aspirin strategy, but not with the aspirin strategy. Incidence of major bleeding was not different between the groups regardless of the no-aspirin and aspirin strategies (5.5% vs 3.3%, P = 0.150, and 6.9% vs 4.3%, P = 0.278)
Conclusions
PPI use was associated with higher risks of cardiovascular events and mortality without decreasing major bleeding in patients undergoing PCI with aspirin-free P2Y12 inhibitor monotherapy. (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111)
背景：质子泵抑制剂（PPIs）在接受无阿司匹林P2Y12抑制剂单药治疗的经皮冠状动脉介入治疗（PCI）患者中的安全性尚不清楚。目的：评价PPIs在PCI合并P2Y12抑制剂单药治疗患者中的作用。方法：我们比较了stopdpt -3试验中有PPI处方和没有PPI处方的患者的结果，该试验纳入了接受PCI治疗的患者，1年内采用无阿司匹林（1个月普拉格雷单药治疗加氯吡格雷单药治疗：n = 2909[急性冠状动脉综合征：n = 2170，高危出血：n = 1580]）和阿司匹林（1个月双抗血小板治疗加阿司匹林单药治疗：n = 2914[急性冠状动脉综合征：n = 2171，高危出血：n = 1566]）策略分层。结果：2418例（83.1%）无阿司匹林患者和2695例（92.5%）阿司匹林患者分别开了PPIs。在倾向评分匹配的队列中（无阿司匹林组：n = 902，阿司匹林组：n = 376）， PPI组心血管死亡、心肌梗死、明确支架血栓形成或卒中的复合发生率高于无阿司匹林组（7.1% vs 2.4%, P = 0.002），但与阿司匹林组相比（6.9% vs 7.4%, P = 0.817）。在不服用阿司匹林的情况下，PPI组的死亡发生率高于不服用PPI组，但服用阿司匹林组的死亡发生率高于不服用PPI组。无论是否使用阿司匹林，两组之间的大出血发生率均无差异（5.5% vs 3.3%, P = 0.150, 6.9% vs 4.3%, P = 0.278）。结论：在接受PCI治疗的无阿司匹林P2Y12抑制剂单药治疗的患者中，PPI的使用与心血管事件和死亡率的高风险相关，且未减少大出血。（依维莫司洗脱钴铬支架-3后双重抗血小板治疗的短期和最佳持续时间[stopdpt -3]； NCT04609111）。
{"title":"Effect of Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention With Aspirin-Free Strategy","authors":"Tenjin Nishikura MD , Ko Yamamoto MD , Kohei Wakabayashi MD , Masahiro Natsuaki MD , Hirotoshi Watanabe MD , Takeshi Morimoto MD, MPH , Yuki Obayashi MD , Ryusuke Nishikawa MD , Tomoya Kimura MD , Kenji Ando MD , Satoru Suwa MD , Tsuyoshi Isawa MD , Hiroyuki Takenaka MD , Tetsuya Ishikawa MD , Yuko Onishi MD , Kiyoshi Hibi MD , Kazuya Kawai MD , Tsutomu Murakami MD , Akihiro Takasaki MD , Nobuya Higashitani MD , Takeshi Kimura MD","doi":"10.1016/j.jacasi.2025.09.015","DOIUrl":"10.1016/j.jacasi.2025.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Safety of proton pump inhibitors (PPIs) in patients undergoing percutaneous coronary intervention (PCI) with aspirin-free P2Y<sub>12</sub> inhibitor monotherapy was unknown.</div></div><div><h3>Objectives</h3><div>The authors aimed to evaluate effects of PPIs in patients undergoing PCI with P2Y<sub>12</sub> inhibitor monotherapy.</div></div><div><h3>Methods</h3><div>We compared outcomes between patients with and without PPI prescription in the STOPDAPT-3 trial enrolling patients undergoing PCI stratified by the no-aspirin (1-month prasugrel monotherapy followed by clopidogrel monotherapy: n = 2,909 [acute coronary syndrome: n = 2,170, high bleeding risk: n = 1,580]) and the aspirin (1-month dual antiplatelet therapy followed by aspirin monotherapy: n = 2,914 [acute coronary syndrome: n = 2,171, high bleeding risk: n = 1,566]) strategies at 1 year.</div></div><div><h3>Results</h3><div>PPIs were prescribed in 2,418 patients (83.1%) with the no-aspirin strategy, and in 2,695 patients (92.5%) with the aspirin strategy. In the propensity score matched cohort (no-aspirin strategy: n = 902 and aspirin strategy: n = 376), a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke more often occurred in the PPI group than in the no-PPI group with the no-aspirin strategy (7.1% vs 2.4%, <em>P</em> = 0.002), but not with the aspirin strategy (6.9% vs 7.4%, <em>P</em> = 0.817). Death also more often occurred in the PPI group than in the no-PPI group with the no-aspirin strategy, but not with the aspirin strategy. Incidence of major bleeding was not different between the groups regardless of the no-aspirin and aspirin strategies (5.5% vs 3.3%, <em>P</em> = 0.150, and 6.9% vs 4.3%, <em>P</em> = 0.278)</div></div><div><h3>Conclusions</h3><div>PPI use was associated with higher risks of cardiovascular events and mortality without decreasing major bleeding in patients undergoing PCI with aspirin-free P2Y<sub>12</sub> inhibitor monotherapy. (ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; <span><span>NCT04609111</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"6 2","pages":"Pages 128-140"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jacasi.2025.10.017
Xiaoyuan Bai MD, PhD , Yiyuan Zhang MD, PhD , Jing Qu PhD , Guang-Hui Liu PhD
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with their prevalence rising with advancing age. Progressive remodeling of the cardiovascular system during aging underlies increased vulnerability to cardiovascular pathologies. This review summarizes current insights into the structural, functional, and molecular hallmarks of both cardiovascular aging (CVA) and CVDs, highlighting their mechanistic convergence. By further discussing diagnostic biomarkers and intervention strategies that bridge these processes, we delineated the translational continuum linking CVA and CVDs. The understanding of their interconnections underscores the potential of targeting CVA as a strategy for CVD prevention, early diagnosis, and treatment.
{"title":"Interconnected Pathways and Therapeutic Implications for Cardiovascular Aging and Diseases","authors":"Xiaoyuan Bai MD, PhD , Yiyuan Zhang MD, PhD , Jing Qu PhD , Guang-Hui Liu PhD","doi":"10.1016/j.jacasi.2025.10.017","DOIUrl":"10.1016/j.jacasi.2025.10.017","url":null,"abstract":"<div><div>Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, with their prevalence rising with advancing age. Progressive remodeling of the cardiovascular system during aging underlies increased vulnerability to cardiovascular pathologies. This review summarizes current insights into the structural, functional, and molecular hallmarks of both cardiovascular aging (CVA) and CVDs, highlighting their mechanistic convergence. By further discussing diagnostic biomarkers and intervention strategies that bridge these processes, we delineated the translational continuum linking CVA and CVDs. The understanding of their interconnections underscores the potential of targeting CVA as a strategy for CVD prevention, early diagnosis, and treatment.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"6 2","pages":"Pages 109-127"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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