Pub Date : 2025-12-24DOI: 10.1016/j.amjcard.2025.12.005
Sanchit Duhan, Narayana Varalakshmi Akula, Krishna Prasad Kurpad, Bijeta Keisham, Sanjay S Mehta, Naveed A Adoni, Mbu Mongwa
Pulsed-field ablation (PFA) is a nonthermal ablation method for pulmonary-vein isolation to treat atrial fibrillation. Limited data are available to compare PFA with cryoballoon ablation (CBA). We searched PubMed, Cochrane, and Embase for studies comparing PFA and CBA with at least one outcome of interest. Data analysis was performed using Cochrane RevMan 5.4. Dichotomous variables were compared using the Mantel-Haenszel method in a random-effects model to calculate the risk ratio and 95% confidence intervals (CI). Continuous variables were compared using the inverse variance method in a random-effects model to calculate standard mean differences (SMD) and 95% CI. Twenty-one studies comprising 5,222 patients (2,297:PFA, 2,925:CBA) were included. Thirteen studies reported AF recurrence after the blanking period of 3 months, with a lower pooled risk seen in PFA (RR 0.81; 95% CI: 0.70, 0.92). Sixteen studies reported a periprocedural complications rate with a lower pooled risk in PFA than in CBA (RR: 0.67; 95% CI: 0.45, 1.00). Eighteen studies reported procedural time, which was lower with PFA (SMD -0.57; 95% CI: 0.88, -0.26). However, fluoroscopy time was higher with PFA (SMD: 0.26; 95% CI: 0.06, 0.46) (15 studies). Three studies reported an increase in high-sensitivity troponin, with higher levels after PFA (SMD: 2.05; 95% CI: 0.50, 3.61). A greater decrease in heart rate was observed in the PFA group postprocedure (SMD: -0.97; 95% CI: -1.73, -0.21) (4 studies). The use of PFA is associated with lower AF recurrence rates, shorter procedure durations, and a more significant decrease in heart rate compared to CBA. The fluoroscopy times are higher with PFA, and periprocedural complication rates are similar to those with CBA.
脉冲场消融（PFA）是肺静脉隔离治疗心房颤动的一种非热消融方法。比较PFA和低温球囊消融（CBA）的数据有限。我们检索了PubMed， Cochrane和Embase，以比较PFA和CBA至少有一个感兴趣的结果。采用Cochrane RevMan 5.4进行数据分析。采用随机效应模型中的Mantel-Haenszel方法比较二分类变量，计算风险比和95%置信区间（CI）。采用随机效应模型中的反方差法比较连续变量，计算标准均值差（SMD）和95% CI。21项研究包括5222例患者（2297例：PFA， 2925例：CBA）。13项研究报告AF在空白期3个月后复发，PFA患者的总风险较低（RR 0.81; 95% CI 0.70, 0.92）。16项研究报告PFA的围手术期并发症发生率低于CBA （RR 0.67; 95% CI 0.45, 1.00）。18项研究报告了PFA患者的手术时间（SMD -0.57; 95% CI 0.88, -0.26）。然而，PFA组透视时间更长（SMD 0.26; 95% CI 0.06, 0.46）（15项研究）。三项研究报告了高敏感性肌钙蛋白的增加，PFA后水平更高（SMD 2.05; 95% CI 0.50, 3.61）。PFA组术后心率下降幅度更大（SMD -0.97; 95% CI -1.73, -0.21）（4项研究）。与CBA相比，PFA的使用与AF复发率较低、手术时间较短、心率下降更显著相关。PFA的透视次数较高，术中并发症发生率与CBA相似。
{"title":"Pulsed-Field Ablation Versus Cryoballoon Ablation for Atrial Fibrillation: A Comparative Analysis.","authors":"Sanchit Duhan, Narayana Varalakshmi Akula, Krishna Prasad Kurpad, Bijeta Keisham, Sanjay S Mehta, Naveed A Adoni, Mbu Mongwa","doi":"10.1016/j.amjcard.2025.12.005","DOIUrl":"10.1016/j.amjcard.2025.12.005","url":null,"abstract":"<p><p>Pulsed-field ablation (PFA) is a nonthermal ablation method for pulmonary-vein isolation to treat atrial fibrillation. Limited data are available to compare PFA with cryoballoon ablation (CBA). We searched PubMed, Cochrane, and Embase for studies comparing PFA and CBA with at least one outcome of interest. Data analysis was performed using Cochrane RevMan 5.4. Dichotomous variables were compared using the Mantel-Haenszel method in a random-effects model to calculate the risk ratio and 95% confidence intervals (CI). Continuous variables were compared using the inverse variance method in a random-effects model to calculate standard mean differences (SMD) and 95% CI. Twenty-one studies comprising 5,222 patients (2,297:PFA, 2,925:CBA) were included. Thirteen studies reported AF recurrence after the blanking period of 3 months, with a lower pooled risk seen in PFA (RR 0.81; 95% CI: 0.70, 0.92). Sixteen studies reported a periprocedural complications rate with a lower pooled risk in PFA than in CBA (RR: 0.67; 95% CI: 0.45, 1.00). Eighteen studies reported procedural time, which was lower with PFA (SMD -0.57; 95% CI: 0.88, -0.26). However, fluoroscopy time was higher with PFA (SMD: 0.26; 95% CI: 0.06, 0.46) (15 studies). Three studies reported an increase in high-sensitivity troponin, with higher levels after PFA (SMD: 2.05; 95% CI: 0.50, 3.61). A greater decrease in heart rate was observed in the PFA group postprocedure (SMD: -0.97; 95% CI: -1.73, -0.21) (4 studies). The use of PFA is associated with lower AF recurrence rates, shorter procedure durations, and a more significant decrease in heart rate compared to CBA. The fluoroscopy times are higher with PFA, and periprocedural complication rates are similar to those with CBA.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"33-40"},"PeriodicalIF":2.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843322","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 : 2025-12-24DOI: 10.1016/j.amjcard.2025.12.003
Uma Sirisha Pusapati MBBS, Sanjai Pattu Valappil DM (Cardiology) , Bharatraj Banavalikar DM (Cardiology) , Soorya Prakash Sundar Rajan MBBS
Renovascular hypertension (RVH) is an under-recognized but potentially reversible cause of secondary hypertension with significant cardiovascular consequences. Excess aldosterone resulting from renin–angiotensin–aldosterone system activation leads to potassium loss, QT-interval prolongation, and increased susceptibility to malignant ventricular arrhythmias. Hypokalemia combined with hypertension-mediated left-ventricular hypertrophy further increases myocardial electrical instability, predisposing to polymorphic ventricular tachycardia (PVT). We report a woman in her fifties who presented with recurrent syncope secondary to PVT associated with severe hypokalemia. Biochemical evaluation revealed elevated plasma renin activity and aldosterone with a low aldosterone-to-renin ratio. Further evaluation with CT angiography demonstrated critical unilateral atherosclerotic renal artery stenosis. Following percutaneous angioplasty and stent placement, blood pressure and serum potassium normalized, and there were no further arrhythmic episodes. This case highlights a rare but clinically important cardiovascular manifestation of unilateral renal artery stenosis presenting as polymorphic ventricular tachycardia. Recognition of hypokalemia-mediated electrophysiological instability as a reversible cause of life-threatening arrhythmia is essential, as timely revascularization can achieve complete clinical resolution.
{"title":"Polymorphic Ventricular Tachycardia as a Manifestation of Unilateral Renal Artery Stenosis","authors":"Uma Sirisha Pusapati MBBS, Sanjai Pattu Valappil DM (Cardiology) , Bharatraj Banavalikar DM (Cardiology) , Soorya Prakash Sundar Rajan MBBS","doi":"10.1016/j.amjcard.2025.12.003","DOIUrl":"10.1016/j.amjcard.2025.12.003","url":null,"abstract":"<div><div>Renovascular hypertension (RVH) is an under-recognized but potentially reversible cause of secondary hypertension with significant cardiovascular consequences. Excess aldosterone resulting from renin–angiotensin–aldosterone system activation leads to potassium loss, QT-interval prolongation, and increased susceptibility to malignant ventricular arrhythmias. Hypokalemia combined with hypertension-mediated left-ventricular hypertrophy further increases myocardial electrical instability, predisposing to polymorphic ventricular tachycardia (PVT). We report a woman in her fifties who presented with recurrent syncope secondary to PVT associated with severe hypokalemia. Biochemical evaluation revealed elevated plasma renin activity and aldosterone with a low aldosterone-to-renin ratio. Further evaluation with CT angiography demonstrated critical unilateral atherosclerotic renal artery stenosis. Following percutaneous angioplasty and stent placement, blood pressure and serum potassium normalized, and there were no further arrhythmic episodes. This case highlights a rare but clinically important cardiovascular manifestation of unilateral renal artery stenosis presenting as polymorphic ventricular tachycardia. Recognition of hypokalemia-mediated electrophysiological instability as a reversible cause of life-threatening arrhythmia is essential, as timely revascularization can achieve complete clinical resolution.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"261 ","pages":"Pages 27-30"},"PeriodicalIF":2.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843288","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 : 2025-12-23DOI: 10.1016/j.amjcard.2025.12.001
Han Xia PhD, Junlei Li PhD, Jianzeng Dong PhD
{"title":"Corrigendum to ‘Clinical Characteristics and Prognosis of Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease’ [The American Journal of Cardiology 257(2025) Pages 101-109]","authors":"Han Xia PhD, Junlei Li PhD, Jianzeng Dong PhD","doi":"10.1016/j.amjcard.2025.12.001","DOIUrl":"10.1016/j.amjcard.2025.12.001","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"260 ","pages":"Page 53"},"PeriodicalIF":2.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145832805","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}
Current guidelines recommend intravascular imaging guidance for percutaneous coronary intervention (PCI). While both optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are endorsed, comparative data in STEMI remain limited. To compare clinical outcomes between OCT and IVUS guidance for primary PCI for ST-elevation myocardial infarction (STEMI). From a multicenter registry of 2,777 consecutive STEMI patients undergoing primary PCI within 24 hours from onset at 12 Japanese hospitals, we analyzed 2,291 patients who received OCT-guided (n = 244, 10.7%) or IVUS-guided (n = 2,047, 89.3%) PCI. The primary endpoint was target vessel-related major adverse cardiac events (TV-MACE): cardiovascular death, target vessel revascularization, and target vessel-related myocardial infarction. Propensity score matching was performed to adjust for baseline differences. During median follow-up of 722 days, TV-MACE rates tended to be lower in the OCT group in unmatched analysis (9.8% vs 14.5%; p = 0.051). After propensity matching (187 pairs), this difference disappeared (8.6% vs 10.2%; p = 0.723). Kaplan–Meier analysis showed no significant differences for TV-MACE (hazard ratio [HR] 0.82, 95% confidence interval [95% CI] 0.42 to 1.59, p = 0.552), cardiovascular death (HR 0.46, 95% CI 0.16 to 1.32, p = 0.150), or target vessel revascularization (HR 1.07, 95% CI 0.43 to 2.63, p = 0.891). OCT guidance was associated with more frequent procedures without stenting (12.8% vs 5.3%, p = 0.027) and fewer stents per patient (0.99 ± 0.52 vs 1.15 ± 0.56, p = 0.006). In conclusion, OCT-guided PCI demonstrated comparable outcomes to IVUS-guided PCI in STEMI patients, supporting the use of either imaging modality for primary PCI.
Condensed abstract: This multicenter registry compared optical coherence tomography (OCT) versus intravascular ultrasound (IVUS) guidance for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). Clinical outcomes were compared between the patients undergoing OCT-guided PCI (n = 244) and those with IVUS-guided PCI (n = 2,047). After propensity score matching (187 pairs), target vessel-related major adverse cardiac events rates were similar between OCT and IVUS groups (8.6% vs 10.2%, p = 0.723) during median 722-day follow-up. No significant differences were observed in cardiovascular death or target vessel revascularization. OCT guidance was associated with more frequent procedures without stenting and fewer stents per patient. Both imaging modalities demonstrated comparable clinical outcomes.
目前的指南推荐PCI的血管内成像指导。虽然OCT和IVUS都得到了认可，但STEMI的比较数据仍然有限。比较光学相干断层扫描（OCT）和血管内超声（IVUS）指导下经皮冠状动脉介入治疗（PCI）治疗st段抬高型心肌梗死（STEMI）的临床结果。来自日本12家医院的2777名连续STEMI患者在24小时内接受了原发性PCI，我们分析了2291名接受oct引导（n = 244,10.7%）或ivus引导（n = 2047,89.3%）PCI的患者。主要终点是靶血管相关的主要心脏不良事件（TV-MACE）：心血管死亡、靶血管血运重建和靶血管相关的心肌梗死。进行倾向评分匹配以调整基线差异。在中位随访722天期间，在非匹配分析中，OCT组的TV-MACE率倾向于较低（9.8% vs. 14.5%; p = 0.051）。倾向匹配（187对）后，这种差异消失（8.6% vs. 10.2%; p = 0.723）。Kaplan-Meier分析显示TV-MACE （HR 0.82, 95% CI 0.42-1.59, p = 0.552）、心血管死亡（HR 0.46, 95% CI 0.16-1.32, p = 0.150）或靶血管重建化（HR 1.07, 95% CI 0.43-2.63, p = 0.891）无显著差异。OCT指导与更频繁的无支架手术相关（12.8% vs. 5.3%, p = 0.027），每位患者较少的支架（0.99±0.52 vs. 1.15±0.56,p = 0.006）。总之，在STEMI患者中，oct引导下的PCI显示出与ivus引导下的PCI相当的结果，支持使用任何一种成像方式进行初级PCI。摘要：这项多中心研究比较了光学相干断层扫描（OCT）和血管内超声（IVUS）指导下st段抬高型心肌梗死（STEMI）的初级经皮冠状动脉介入治疗（PCI）。比较oct引导下PCI患者（n = 244）和ivus引导下PCI患者（n = 2047）的临床结果。在倾向评分匹配（187对）后，在中位722天的随访期间，OCT组和IVUS组与靶血管相关的主要心脏不良事件发生率相似（8.6% vs. 10.2%, p = 0.723）。在心血管死亡或靶血管重建方面没有观察到显著差异。OCT指导与更频繁的无支架手术和每位患者更少的支架相关。两种成像方式显示出相当的临床结果。
{"title":"Optical Coherence Tomography versus Intravascular Ultrasound-Guided Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: A Multicenter Propensity-Matched Analysis","authors":"Ikhtiyorjon Khamdamov MD , Makoto Araki MD, PhD , Taishi Yonetsu MD, PhD , Yuji Matsuda MD, PhD , Ken Kurihara MD, PhD , Shigeo Shimizu MD, PhD , Daisuke Ueshima MD, PhD , Hiroshi Inagaki MD, PhD , Yuko Onishi MD, PhD , Kaoru Sakurai MD, PhD , Takaaki Tsuchiyama MD, PhD , Takashi Ashikaga MD, PhD , Hiroyuki Fujii MD, PhD , Kazuo Kobayashi MD, PhD , Yosuke Yamakami MD , Tomoyo Sugiyama MD, PhD , Tomoyuki Umemoto MD, PhD , Tsunekazu Kakuta MD, PhD , Tetsuo Sasano MD, PhD","doi":"10.1016/j.amjcard.2025.11.020","DOIUrl":"10.1016/j.amjcard.2025.11.020","url":null,"abstract":"<div><div>Current guidelines recommend intravascular imaging guidance for percutaneous coronary intervention (PCI). While both optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are endorsed, comparative data in STEMI remain limited. To compare clinical outcomes between OCT and IVUS guidance for primary PCI for ST-elevation myocardial infarction (STEMI). From a multicenter registry of 2,777 consecutive STEMI patients undergoing primary PCI within 24 hours from onset at 12 Japanese hospitals, we analyzed 2,291 patients who received OCT-guided (n = 244, 10.7%) or IVUS-guided (n = 2,047, 89.3%) PCI. The primary endpoint was target vessel-related major adverse cardiac events (TV-MACE): cardiovascular death, target vessel revascularization, and target vessel-related myocardial infarction. Propensity score matching was performed to adjust for baseline differences. During median follow-up of 722 days, TV-MACE rates tended to be lower in the OCT group in unmatched analysis (9.8% vs 14.5%; p = 0.051). After propensity matching (187 pairs), this difference disappeared (8.6% vs 10.2%; p = 0.723). Kaplan–Meier analysis showed no significant differences for TV-MACE (hazard ratio [HR] 0.82, 95% confidence interval [95% CI] 0.42 to 1.59, p = 0.552), cardiovascular death (HR 0.46, 95% CI 0.16 to 1.32, p = 0.150), or target vessel revascularization (HR 1.07, 95% CI 0.43 to 2.63, p = 0.891). OCT guidance was associated with more frequent procedures without stenting (12.8% vs 5.3%, p = 0.027) and fewer stents per patient (0.99 ± 0.52 vs 1.15 ± 0.56, p = 0.006). In conclusion, OCT-guided PCI demonstrated comparable outcomes to IVUS-guided PCI in STEMI patients, supporting the use of either imaging modality for primary PCI.</div><div>Condensed abstract: This multicenter registry compared optical coherence tomography (OCT) versus intravascular ultrasound (IVUS) guidance for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). Clinical outcomes were compared between the patients undergoing OCT-guided PCI (n = 244) and those with IVUS-guided PCI (n = 2,047). After propensity score matching (187 pairs), target vessel-related major adverse cardiac events rates were similar between OCT and IVUS groups (8.6% vs 10.2%, p = 0.723) during median 722-day follow-up. No significant differences were observed in cardiovascular death or target vessel revascularization. OCT guidance was associated with more frequent procedures without stenting and fewer stents per patient. Both imaging modalities demonstrated comparable clinical outcomes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"261 ","pages":"Pages 8-17"},"PeriodicalIF":2.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800371","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 : 2025-12-15DOI: 10.1016/j.amjcard.2025.12.002
Johny Nicolas, George Dangas, Amanda Borrow, Rüdiger Smolnik, Felix Just, Cathy Chen, Krishna Padmanabhan, Eva-Maria Fronk, Christian Hengstenberg, Nicolas Van Mieghem, Martin Unverdorben
Patients with atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR) remain at risk of ischemic stroke (IS) and bleeding. However, traditional risk scores provide modest predictions of IS and bleeding in these patients. We aimed to develop machine learning (ML) models that predict IS, major gastrointestinal bleeding (MGIB), all clinically relevant bleeding (CRB), and net adverse clinical events (NACE) using data from patients in the ENVISAGE-TAVI AF trial. Ten ML algorithms were trained per outcome using nested cross-validation; the best-performing model (highest F1 score) was validated on a 25% holdout set. Model performance was compared with logistic regression models using CHA₂DS₂-VA or HAS-BLED. Among 1,377 patients, 41 had an IS, 83 had MGIB, 375 had CRB, and 255 experienced NACE. The predictive abilities of a linear discriminant analysis algorithm for IS (F1 score = 0.08) and CHA₂DS₂-VA (F1 score = 0.09) were similarly low, but numerically better than HAS-BLED (F1 score = 0.05). Prediction of MGIB was similarly low for a logistic-lasso algorithm (F1 score = 0.11), CHA₂DS₂-VA (F1 score = 0.09), and HAS-BLED (F1 score = 0.12). For CRB, the predictive performance of a Naïve Bayes algorithm (F1 score = 0.39) was similar to CHA₂DS₂-VA (F1 score = 0.38) and HAS-BLED (F1 score = 0.41). The predictive ability of a logistic regression algorithm for NACE (F1 score = 0.33) was numerically better than CHA₂DS₂-VA (F1 score = 0.22) or HAS-BLED (F1 score = 0.27). In conclusion, ML offered similar predictive ability to established risk scores for thromboembolic and bleeding outcomes among transcatheter aortic valve replacement (TAVR) patients with AF.
{"title":"Comparative Performance of Machine Learning and Traditional Risk Scores in Predicting Adverse Events After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation.","authors":"Johny Nicolas, George Dangas, Amanda Borrow, Rüdiger Smolnik, Felix Just, Cathy Chen, Krishna Padmanabhan, Eva-Maria Fronk, Christian Hengstenberg, Nicolas Van Mieghem, Martin Unverdorben","doi":"10.1016/j.amjcard.2025.12.002","DOIUrl":"10.1016/j.amjcard.2025.12.002","url":null,"abstract":"<p><p>Patients with atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR) remain at risk of ischemic stroke (IS) and bleeding. However, traditional risk scores provide modest predictions of IS and bleeding in these patients. We aimed to develop machine learning (ML) models that predict IS, major gastrointestinal bleeding (MGIB), all clinically relevant bleeding (CRB), and net adverse clinical events (NACE) using data from patients in the ENVISAGE-TAVI AF trial. Ten ML algorithms were trained per outcome using nested cross-validation; the best-performing model (highest F1 score) was validated on a 25% holdout set. Model performance was compared with logistic regression models using CHA₂DS₂-VA or HAS-BLED. Among 1,377 patients, 41 had an IS, 83 had MGIB, 375 had CRB, and 255 experienced NACE. The predictive abilities of a linear discriminant analysis algorithm for IS (F1 score = 0.08) and CHA₂DS₂-VA (F1 score = 0.09) were similarly low, but numerically better than HAS-BLED (F1 score = 0.05). Prediction of MGIB was similarly low for a logistic-lasso algorithm (F1 score = 0.11), CHA₂DS₂-VA (F1 score = 0.09), and HAS-BLED (F1 score = 0.12). For CRB, the predictive performance of a Naïve Bayes algorithm (F1 score = 0.39) was similar to CHA₂DS₂-VA (F1 score = 0.38) and HAS-BLED (F1 score = 0.41). The predictive ability of a logistic regression algorithm for NACE (F1 score = 0.33) was numerically better than CHA₂DS₂-VA (F1 score = 0.22) or HAS-BLED (F1 score = 0.27). In conclusion, ML offered similar predictive ability to established risk scores for thromboembolic and bleeding outcomes among transcatheter aortic valve replacement (TAVR) patients with AF.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773355","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}
Coronary artery disease (CAD) is commonly found in patients with severe aortic stenosis (AS) and combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) is currently recommended as the preferred treatment in this setting. Transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) represent a valid alternative. This study sought to investigate clinical outcomes after TAVR+PCI versus SAVR+CABG in patients with severe AS and CAD. A systematic review was conducted from inception until December 2024 for randomized controlled and propensity score-matched studies comparing TAVR+PCI and SAVR+CABG for patients with severe AS and CAD. Kaplan–Meier-derived individual patient data was retrieved when available. Primary endpoint was all-cause mortality. The study was registered with PROSPERO (CRD42025642206). Six studies met our inclusion criteria with a total of 1,998 patients: 1,007 in the TAVR+PCI group and 991 in the SAVR+CABG group. The hazard ratio of all-cause mortality varied over time between groups: TAVR+PCI showed a lower incidence of all-cause mortality in the first 19 days, with a reversal at 73 days favoring SAVR+CABG. Patients undergoing TAVR+PCI group experienced lower rates of stroke-free survival (p = 0.039), postoperative reintervention (p = 0.020), atrial fibrillation (p <0.001), and acute kidney injury (p = 0.001) rates, while they were at higher risk of postoperative moderate/severe aortic regurgitation (p <0.001), permanent pacemaker implantation (p = 0.005) and major vascular complication (p <0.001). Major bleeding didn’t differ (p = 0.358). A percutaneous treatment approach offered an early survival benefit over a surgical approach in patients with severe AS and CAD but was associated with worse survival at mid-term follow-up.
{"title":"Transcatheter or Surgical Strategy for Aortic Stenosis and Coronary Artery Disease: A Kaplan–Meier-Derived Meta-Analysis","authors":"Massimo Baudo MD , Pier Pasquale Leone MD, MSc , Serge Sicouri MD , Dimitrios E. Magouliotis MD, PhD, MSc , Yoshiyuki Yamashita MD, PhD , Francesco Cabrucci MD , Matteo Sturla MD , Azeem Latib MD , Basel Ramlawi MD","doi":"10.1016/j.amjcard.2025.11.018","DOIUrl":"10.1016/j.amjcard.2025.11.018","url":null,"abstract":"<div><div>Coronary artery disease (CAD) is commonly found in patients with severe aortic stenosis (AS) and combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) is currently recommended as the preferred treatment in this setting. Transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) represent a valid alternative. This study sought to investigate clinical outcomes after TAVR+PCI versus SAVR+CABG in patients with severe AS and CAD. A systematic review was conducted from inception until December 2024 for randomized controlled and propensity score-matched studies comparing TAVR+PCI and SAVR+CABG for patients with severe AS and CAD. Kaplan–Meier-derived individual patient data was retrieved when available. Primary endpoint was all-cause mortality. The study was registered with PROSPERO (CRD42025642206). Six studies met our inclusion criteria with a total of 1,998 patients: 1,007 in the TAVR+PCI group and 991 in the SAVR+CABG group. The hazard ratio of all-cause mortality varied over time between groups: TAVR+PCI showed a lower incidence of all-cause mortality in the first 19 days, with a reversal at 73 days favoring SAVR+CABG. Patients undergoing TAVR+PCI group experienced lower rates of stroke-free survival (p = 0.039), postoperative reintervention (p = 0.020), atrial fibrillation (p <0.001), and acute kidney injury (p = 0.001) rates, while they were at higher risk of postoperative moderate/severe aortic regurgitation (p <0.001), permanent pacemaker implantation (p = 0.005) and major vascular complication (p <0.001). Major bleeding didn’t differ (p = 0.358). A percutaneous treatment approach offered an early survival benefit over a surgical approach in patients with severe AS and CAD but was associated with worse survival at mid-term follow-up.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"260 ","pages":"Pages 80-88"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773301","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 : 2025-12-12DOI: 10.1016/j.amjcard.2025.11.014
Samantha Pozo Navarro BS , Kendall Hammonds MPH , Timothy Mixon MD , Srini Potluri MD , Karim Al-Azizi MD , Molly I. Szerlip MD , J. Michael DiMaio MD , R. Jay Widmer MD, PhD
Observational data have demonstrated that patients presenting with acute coronary syndromes (ACS) and multivessel coronary artery disease (MV-CAD) experience improved 1-year outcomes including lower rates of death, rehospitalization, and repeat ACS when treated with coronary artery bypass graft (CABG) compared with percutaneous coronary intervention (PCI) and medical management (MM). However, limited data exists that studies these practices in adults over the age of 75. This retrospective, multi-centered, observational study from 2018 to 2022 from a healthcare center in Texas compared outcomes among patients with ACS and MV-CAD, stratified by revascularization strategy and age group (<75 vs ≥75 years). The primary endpoint was 1 year mortality, and secondary endpoints include readmission or myocardial infarction (MI) within 1 year, index length of stay, and repeat revascularization within 30 days and 1 year. Cox proportional hazards modeling was used to evaluate the effect of age on mortality outcomes. A total of 2161 patients met inclusion criteria (n = 1559 CABG, n = 295 PCI, and n = 307 MM). There were 1547 patients under the age of 75 (median age 63.82, IQR = 57.24, 69.44) and 614 over the age of 75 (median age 80.43, IQR = 77.62-84.58). Patients who underwent CABG had significantly reduced mortality compared with PCI or MM (RR = 0.324, CI 0.172 to 0.612, p <0.0001). In conclusion, CABG was associated with improved and comparable outcomes in patients with ACS and MV-CAD both under and over 75 years of age compared with PCI and MM.
{"title":"Revascularization in Patients Over 75 With Acute Coronary Syndrome","authors":"Samantha Pozo Navarro BS , Kendall Hammonds MPH , Timothy Mixon MD , Srini Potluri MD , Karim Al-Azizi MD , Molly I. Szerlip MD , J. Michael DiMaio MD , R. Jay Widmer MD, PhD","doi":"10.1016/j.amjcard.2025.11.014","DOIUrl":"10.1016/j.amjcard.2025.11.014","url":null,"abstract":"<div><div>Observational data have demonstrated that patients presenting with acute coronary syndromes (ACS) and multivessel coronary artery disease (MV-CAD) experience improved 1-year outcomes including lower rates of death, rehospitalization, and repeat ACS when treated with coronary artery bypass graft (CABG) compared with percutaneous coronary intervention (PCI) and medical management (MM). However, limited data exists that studies these practices in adults over the age of 75. This retrospective, multi-centered, observational study from 2018 to 2022 from a healthcare center in Texas compared outcomes among patients with ACS and MV-CAD, stratified by revascularization strategy and age group (<75 vs ≥75 years). The primary endpoint was 1 year mortality, and secondary endpoints include readmission or myocardial infarction (MI) within 1 year, index length of stay, and repeat revascularization within 30 days and 1 year. Cox proportional hazards modeling was used to evaluate the effect of age on mortality outcomes. A total of 2161 patients met inclusion criteria (<em>n</em> = 1559 CABG, <em>n</em> = 295 PCI, and <em>n</em> = 307 MM). There were 1547 patients under the age of 75 (median age 63.82, IQR = 57.24, 69.44) and 614 over the age of 75 (median age 80.43, IQR = 77.62-84.58). Patients who underwent CABG had significantly reduced mortality compared with PCI or MM (RR = 0.324, CI 0.172 to 0.612, p <0.0001). In conclusion, CABG was associated with improved and comparable outcomes in patients with ACS and MV-CAD both under and over 75 years of age compared with PCI and MM.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"261 ","pages":"Pages 18-22"},"PeriodicalIF":2.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145754975","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 : 2025-12-07DOI: 10.1016/j.amjcard.2025.11.015
Christian Nitsche MD, PhD , George D. Thornton MD, MRCP , Jonathan Bennett MD, MRCP , Francisco Gama MD , Suchi Chadalavadha , Nish Chaturvedi MBBS, MD , Therese Tillin PhD , Charlotte Manisty MD, PhD, MRCP , Arantxa González MD, PhD , Eylem Levelt DPhil, MRCP , James C Moon MD, MRCP, PhD , Alun D Hughes MBBS, PhD , Anish N Bhuva MBBS, MRCP, PhD , Thomas A Treibel MD, FRCP, PhD
In patients with aortic stenosis (AS), the relation of cardiac energetic pathways with cardiac structure and function, their changes, and their prognostic significance are not well understood. We aimed to characterize metabolic profiles in patients with severe AS before and after aortic valve replacement (AVR) and their association with functional status, structural remodeling and mortality. Patients with symptomatic, severe AS before (n = 143) and 1-year after (n = 113) AVR underwent cardiac magnetic resonance (CMR), serum cardiac biomarkers, and 6-minute walk test. Resting nonfasting plasma samples underwent targeted nuclear magnetic resonance (NMR) for fatty acids (FA), branched chain amino acids (BCAAs), glycolysis-related metabolites, and ketones. Lower FA and BCAA concentrations, but not glycolysis metabolites or ketones, correlated with greater myocardial mass and focal fibrosis, NT-proBNP, TnT and 6-minute walk distance. After 10.5 years of follow-up (66/143 deaths), lower FAs and BCAAs, but not ketones were independently associated with higher mortality risk (p <0.05). At 1-year after AVR, FAs had decreased compared to baseline. In conclusion, reduced serum FA and BCAA concentrations are cardiac, maladaptive, prognostic metabolic changes to AS, which are not reversible after AVR. Whether these markers may be used to guide the timing of AVR or provide metabolic risk stratification remains to be evaluated by future research. In patients with AS systemic metabolomics and their association with myocardial remodeling and outcome after AVR are largely unknown. We show that in severe AS low levels of unsaturated FA and BCAAs correlate with higher mortality risk, and biomarkers measured by CMR, serum, and functional incapacity, and do not increase after AVR. This may provide an alternate approach to risk stratification using blood biomarkers or guide targeted therapies to myocardial energetics before or after AVR.
{"title":"Metabolic Markers of Mortality Risk in Patients With Severe Aortic Stenosis Undergoing Valve Replacement","authors":"Christian Nitsche MD, PhD , George D. Thornton MD, MRCP , Jonathan Bennett MD, MRCP , Francisco Gama MD , Suchi Chadalavadha , Nish Chaturvedi MBBS, MD , Therese Tillin PhD , Charlotte Manisty MD, PhD, MRCP , Arantxa González MD, PhD , Eylem Levelt DPhil, MRCP , James C Moon MD, MRCP, PhD , Alun D Hughes MBBS, PhD , Anish N Bhuva MBBS, MRCP, PhD , Thomas A Treibel MD, FRCP, PhD","doi":"10.1016/j.amjcard.2025.11.015","DOIUrl":"10.1016/j.amjcard.2025.11.015","url":null,"abstract":"<div><div>In patients with aortic stenosis (AS), the relation of cardiac energetic pathways with cardiac structure and function, their changes, and their prognostic significance are not well understood. We aimed to characterize metabolic profiles in patients with severe AS before and after aortic valve replacement (AVR) and their association with functional status, structural remodeling and mortality. Patients with symptomatic, severe AS before (<em>n</em> = 143) and 1-year after (<em>n</em> = 113) AVR underwent cardiac magnetic resonance (CMR), serum cardiac biomarkers, and 6-minute walk test. Resting nonfasting plasma samples underwent targeted nuclear magnetic resonance (NMR) for fatty acids (FA), branched chain amino acids (BCAAs), glycolysis-related metabolites, and ketones. Lower FA and BCAA concentrations, but not glycolysis metabolites or ketones, correlated with greater myocardial mass and focal fibrosis, NT-proBNP, TnT and 6-minute walk distance. After 10.5 years of follow-up (66/143 deaths), lower FAs and BCAAs, but not ketones were independently associated with higher mortality risk (p <0.05). At 1-year after AVR, FAs had decreased compared to baseline. In conclusion, reduced serum FA and BCAA concentrations are cardiac, maladaptive, prognostic metabolic changes to AS, which are not reversible after AVR. Whether these markers may be used to guide the timing of AVR or provide metabolic risk stratification remains to be evaluated by future research. In patients with AS systemic metabolomics and their association with myocardial remodeling and outcome after AVR are largely unknown. We show that in severe AS low levels of unsaturated FA and BCAAs correlate with higher mortality risk, and biomarkers measured by CMR, serum, and functional incapacity, and do not increase after AVR. This may provide an alternate approach to risk stratification using blood biomarkers or guide targeted therapies to myocardial energetics before or after AVR.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"261 ","pages":"Pages 1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712977","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}
Data on the safety and efficacy of transcatheter aortic valve replacement (TAVR) for the treatment of aortic valve stenosis in immunocompromised (IC) patients is scarce, while it represents a valid alternative to surgical AVR in this vulnerable population. This meta-analysis aims to compare the clinical outcomes of TAVR in IC versus non-IC patients. A comprehensive search was conducted across PubMed, EMBASE, and Cochrane Central for randomized controlled trials and observational studies that compared outcomes between IC and non-IC patients undergoing TAVR. Primary outcomes included 1-year all-cause, cardiovascular (CV) and non-CV mortality. Secondary outcomes included new permanent pacemaker implantation (PPI) and major periprocedural complications. 4,478 patients in 7 studies (mean age 80.5 years, 7.64% IC) were included in the analysis. As compared with non-IC patients, IC patients exhibited a similar 30-day death rate (Odds Ratio [OR] 1.62; 95% Confidence Interval [CI] 0.68 to 3.98; p = 0.297), but significantly higher 1-year all-cause mortality (OR 2.39; 95% CI 1.55 to 3.70; p <0.001). Notably, IC patients demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 to 0.59; p = 0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 to 10.18; p = 0.002). There was no difference in the rate of new PPI or major periprocedural complications. In conclusion, TAVR is a safe and effective treatment strategy in IC patients, with similar short-term mortality and increased medium-term mortality risk as compared with non-IC patients. (PROSPERO: CRD42024623229)
关于经导管主动脉瓣置换术（TAVR）治疗免疫功能低下（IC）患者主动脉瓣狭窄的安全性和有效性的数据很少，但它在这一脆弱人群中代表了手术AVR的有效替代方案。本荟萃分析旨在比较TAVR在IC和非IC患者中的临床结果。在PubMed、EMBASE和Cochrane Central进行了一项全面的搜索，以比较IC和非IC患者接受TAVR的结果的随机对照试验和观察性研究。主要结局包括1年全因死亡率、心血管死亡率和非心血管死亡率。次要结果包括新的永久性起搏器植入（PPI）和主要围手术期并发症。7项研究的4478例患者（平均年龄80.5岁，IC为7.64%）被纳入分析。与非IC患者相比，IC患者的30天死亡率相似(优势比（OR） 1.62；95%置信区间（CI） 0.68 - 3.98；p=0.297)，但1年全因死亡率显著升高（OR 2.39; 95% CI 1.55 - 3.70; p < 0.001）。值得注意的是，IC患者CV死亡风险较低（OR 0.24; 95% CI 0.10 - 0.59; p = 0.002），但非CV死亡风险较高（OR 4.16; 95% CI 1.70 - 10.18; p = 0.002）。在新的PPI和主要围手术期并发症的发生率方面没有差异。综上所述，TAVR是一种安全有效的治疗策略，与非IC患者相比，其短期死亡率相似，中期死亡率风险增加。(普洛斯彼罗:CRD42024623229)。
{"title":"Transcatheter Aortic Valve Replacement in the Immunocompromised: A Systematic Review and Meta-Analysis","authors":"Roel Meeus MD , Pavell Dhondt MD , Nele Meeus , Hadiah Ashraf , Lennert Minten MD, PhD , Jesslyn Hariyanto MD , Christophe Dubois MD, PhD","doi":"10.1016/j.amjcard.2025.11.017","DOIUrl":"10.1016/j.amjcard.2025.11.017","url":null,"abstract":"<div><div>Data on the safety and efficacy of transcatheter aortic valve replacement (TAVR) for the treatment of aortic valve stenosis in immunocompromised (IC) patients is scarce, while it represents a valid alternative to surgical AVR in this vulnerable population. This meta-analysis aims to compare the clinical outcomes of TAVR in IC versus non-IC patients. A comprehensive search was conducted across PubMed, EMBASE, and Cochrane Central for randomized controlled trials and observational studies that compared outcomes between IC and non-IC patients undergoing TAVR. Primary outcomes included 1-year all-cause, cardiovascular (CV) and non-CV mortality. Secondary outcomes included new permanent pacemaker implantation (PPI) and major periprocedural complications. 4,478 patients in 7 studies (mean age 80.5 years, 7.64% IC) were included in the analysis. As compared with non-IC patients, IC patients exhibited a similar 30-day death rate (Odds Ratio [OR] 1.62; 95% Confidence Interval [CI] 0.68 to 3.98; p = 0.297), but significantly higher 1-year all-cause mortality (OR 2.39; 95% CI 1.55 to 3.70; p <0.001). Notably, IC patients demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 to 0.59; p = 0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 to 10.18; p = 0.002). There was no difference in the rate of new PPI or major periprocedural complications. In conclusion, TAVR is a safe and effective treatment strategy in IC patients, with similar short-term mortality and increased medium-term mortality risk as compared with non-IC patients. (PROSPERO: CRD42024623229)</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"260 ","pages":"Pages 71-79"},"PeriodicalIF":2.1,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686807","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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