Pub Date : 2026-02-25DOI: 10.1016/j.ahj.2026.107385
Richard Casazza, Arsalan Hashmi, Joshua Fogel, Jacob Shani
Background: The radial artery approach is the predominant access site for percutaneous coronary interventions (PCI) due to its safety profile. Most centers prefer the right-radial artery approach (RRA) due to historical laboratory configurations. However, a reduction in operator radiation exposure (ORE) has been theorized for the left-radial artery approach (LRA) due to better shielding and more favorable subclavian artery anatomy.
Objectives: To compare ORE between the LRA and RRA during cardiac catheterization.
Methods: We performed a meta-analysis of ORE comparing LRA and RRA. The ratio of means (ROM) was used to estimate the mean effect size.
Results: This analysis includes 10 studies with 5,168 procedures (LRA, n = 2,410 vs RRA, n = 2,758). Cumulative ORE favored the LRA with lower levels at the thorax (ROM = 0.68, 95% CI: 0.52, 0.88, P <.001), left wrist (ROM = 0.64, 95% CI: 0.45, 0.93, P = .02), and neck (ROM = 0.68, 95% CI: 0.53, 0.86, P <.001). Cumulative ORE did not favor either the LRA or RRA at the left eye (ROM = 0.83, 95% CI: 0.63, 1.11, P = .22). Heterogeneity was high for thorax, left eye, and left wrist but not for neck. Possible publication bias was not present for thorax, left eye, and neck while left wrist had possible publication bias (Egger test: P = .02).
Conclusions: We recommend that the LRA should be the primary access site for operators in order to reduce ORE in laboratories with standard shielding configurations.
{"title":"Operator radiation exposure comparing left-radial artery and right-radial artery approaches: A systematic review and meta-analysis.","authors":"Richard Casazza, Arsalan Hashmi, Joshua Fogel, Jacob Shani","doi":"10.1016/j.ahj.2026.107385","DOIUrl":"10.1016/j.ahj.2026.107385","url":null,"abstract":"<p><strong>Background: </strong>The radial artery approach is the predominant access site for percutaneous coronary interventions (PCI) due to its safety profile. Most centers prefer the right-radial artery approach (RRA) due to historical laboratory configurations. However, a reduction in operator radiation exposure (ORE) has been theorized for the left-radial artery approach (LRA) due to better shielding and more favorable subclavian artery anatomy.</p><p><strong>Objectives: </strong>To compare ORE between the LRA and RRA during cardiac catheterization.</p><p><strong>Methods: </strong>We performed a meta-analysis of ORE comparing LRA and RRA. The ratio of means (ROM) was used to estimate the mean effect size.</p><p><strong>Results: </strong>This analysis includes 10 studies with 5,168 procedures (LRA, n = 2,410 vs RRA, n = 2,758). Cumulative ORE favored the LRA with lower levels at the thorax (ROM = 0.68, 95% CI: 0.52, 0.88, P <.001), left wrist (ROM = 0.64, 95% CI: 0.45, 0.93, P = .02), and neck (ROM = 0.68, 95% CI: 0.53, 0.86, P <.001). Cumulative ORE did not favor either the LRA or RRA at the left eye (ROM = 0.83, 95% CI: 0.63, 1.11, P = .22). Heterogeneity was high for thorax, left eye, and left wrist but not for neck. Possible publication bias was not present for thorax, left eye, and neck while left wrist had possible publication bias (Egger test: P = .02).</p><p><strong>Conclusions: </strong>We recommend that the LRA should be the primary access site for operators in order to reduce ORE in laboratories with standard shielding configurations.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107385"},"PeriodicalIF":3.5,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147315980","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 : 2026-02-24DOI: 10.1016/j.ahj.2026.107386
Namratha Atluri, Lauren Herty, Carly Runge, Joanna Wells, Margaret Scisney-Matlock, Scott L Hummel
Background: Hypertension and obesity disproportionately affect veterans and contribute to cardiovascular disease. The sodium-restricted Dietary Approaches to Stop Hypertension eating pattern (DASH-SRD) reduces blood pressure (BP) and is guideline-recommended, but adherence is low in this population. We conducted a randomized trial of a remotely delivered dietary intervention to promote and sustain adoption of DASH-SRD in veterans with hypertension and obesity.
Methods: Veterans with hypertension and obesity received 2 weeks of home-delivered DASH-SRD meals after 2 weeks of ad-lib diet (Phase 1), then 5 telephone-delivered, dietitian-led motivational interviewing counseling sessions over 4 months, with or without a newly developed mobile application (Phase 2). DASH adherence (score 0-9 per 3-day food diary), clinic blood pressure (BP), and urinary sodium:potassium ratio was collected at baseline and at months 1 and 6 of Phase 2. Generalized estimating equations were used to evaluate changes in these parameters during the intervention.
Results: Sixty-one veterans (age 67 ± 8 years, 15% female, 16% non-White) with obesity (BMI 34.4 ± 5.2) and hypertension completed the trial. Dietary counseling session attendance was 96%. Between baseline and 6 months, DASH adherence score improved (1.8 ± 1.6-2.3 ± 1.4 points, P = .02), BP decreased (systolic 133 ± 17-128 ± 15 mmHg, P = .048; diastolic 73 ± 11-69 ± 12 mmHg, P = .03), and urinary sodium:potassium ratio declined (2.6 ± 1.1-1.5 ± 0.8, P < .001). There were no significant differences between the mobile application plus counseling and counseling-alone groups.
Conclusion: In Veterans with hypertension and obesity, a brief interval of home-delivered meals followed by telephone dietitian counseling sustainably improved DASH-SRD adherence and reduced BP.
{"title":"Remote dietitian counseling with short-term meal delivery improves DASH diet adherence and lowers blood pressure in veterans with hypertension and obesity.","authors":"Namratha Atluri, Lauren Herty, Carly Runge, Joanna Wells, Margaret Scisney-Matlock, Scott L Hummel","doi":"10.1016/j.ahj.2026.107386","DOIUrl":"10.1016/j.ahj.2026.107386","url":null,"abstract":"<p><strong>Background: </strong>Hypertension and obesity disproportionately affect veterans and contribute to cardiovascular disease. The sodium-restricted Dietary Approaches to Stop Hypertension eating pattern (DASH-SRD) reduces blood pressure (BP) and is guideline-recommended, but adherence is low in this population. We conducted a randomized trial of a remotely delivered dietary intervention to promote and sustain adoption of DASH-SRD in veterans with hypertension and obesity.</p><p><strong>Methods: </strong>Veterans with hypertension and obesity received 2 weeks of home-delivered DASH-SRD meals after 2 weeks of ad-lib diet (Phase 1), then 5 telephone-delivered, dietitian-led motivational interviewing counseling sessions over 4 months, with or without a newly developed mobile application (Phase 2). DASH adherence (score 0-9 per 3-day food diary), clinic blood pressure (BP), and urinary sodium:potassium ratio was collected at baseline and at months 1 and 6 of Phase 2. Generalized estimating equations were used to evaluate changes in these parameters during the intervention.</p><p><strong>Results: </strong>Sixty-one veterans (age 67 ± 8 years, 15% female, 16% non-White) with obesity (BMI 34.4 ± 5.2) and hypertension completed the trial. Dietary counseling session attendance was 96%. Between baseline and 6 months, DASH adherence score improved (1.8 ± 1.6-2.3 ± 1.4 points, P = .02), BP decreased (systolic 133 ± 17-128 ± 15 mmHg, P = .048; diastolic 73 ± 11-69 ± 12 mmHg, P = .03), and urinary sodium:potassium ratio declined (2.6 ± 1.1-1.5 ± 0.8, P < .001). There were no significant differences between the mobile application plus counseling and counseling-alone groups.</p><p><strong>Conclusion: </strong>In Veterans with hypertension and obesity, a brief interval of home-delivered meals followed by telephone dietitian counseling sustainably improved DASH-SRD adherence and reduced BP.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/study/NCT03170375.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107386"},"PeriodicalIF":3.5,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300857","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 : 2026-02-23DOI: 10.1016/j.ahj.2026.107387
Troels Thim, Henrik Nissen, Matti Niemelä, Ashkan Eftekhari, Mikko Jalanko, Mikko Savontaus, Pertti Jääskeläinen, Mark Hensey, Rebekka Vibjerg Jensen, Bjarne Linde Nørgaard, Christian Alcaraz Frederiksen, Henrik Ølholm Vase, Lars Pedersen, Henrik Toft Sørensen, Evald Høj Christiansen, Christian Juhl Terkelsen
Introduction: The COMPARE-TAVI trial framework was launched for direct comparison of transcatheter aortic valve implantation (TAVI) valves. The COMPARE-TAVI 1 trial, comparing Myval/Myval Octacor versus Sapien 3/Sapien 3 Ultra transcatheter heart valves (THVs), was recently published. Here, we present the design and rationale for the COMPARE-TAVI 2 trial comparing the Evolut FX+ self-expandable THV with the Sapien 3 Ultra Resilia balloon-expandable THV.
Methods and analysis: In the COMPARE-TAVI 2 trial (ClinicalTrials.gov NCT06470022), patients will be randomized 1:1 between the THVs. The trial will test whether the Evolut FX+ self-expandable THV is noninferior to the Sapien 3 Ultra Resilia balloon-expandable THV in terms of the combined 1-year primary composite endpoint of all-cause mortality, stroke, moderate/severe total aortic regurgitation, or moderate/severe hemodynamic THV deterioration, according to VARC-3 criteria. If noninferiority is proven, superiority analyses may apply. Based on a power of 80%, alpha level of 0.05, 1-sided test, noninferiority margin of 4.5%, and expected event rate of 12%, the necessary sample size has been estimated to be 1,364 patients. Prespecified secondary endpoints, including long-term follow-up for 10 years, will also be investigated.
Summary: The COMPARE-TAVI 2 will provide important information on the short- and long-term outcomes among patients treated with the Evolut FX+ self-expandable and the Sapien 3 Ultra Resilia balloon-expandable THVs.
{"title":"Design and rationale of the COMPARE-TAVI 2 trial: An all-comers head-to-head comparison of Evolut FX+ and Sapien 3 Ultra Resilia transcatheter heart valves.","authors":"Troels Thim, Henrik Nissen, Matti Niemelä, Ashkan Eftekhari, Mikko Jalanko, Mikko Savontaus, Pertti Jääskeläinen, Mark Hensey, Rebekka Vibjerg Jensen, Bjarne Linde Nørgaard, Christian Alcaraz Frederiksen, Henrik Ølholm Vase, Lars Pedersen, Henrik Toft Sørensen, Evald Høj Christiansen, Christian Juhl Terkelsen","doi":"10.1016/j.ahj.2026.107387","DOIUrl":"10.1016/j.ahj.2026.107387","url":null,"abstract":"<p><strong>Introduction: </strong>The COMPARE-TAVI trial framework was launched for direct comparison of transcatheter aortic valve implantation (TAVI) valves. The COMPARE-TAVI 1 trial, comparing Myval/Myval Octacor versus Sapien 3/Sapien 3 Ultra transcatheter heart valves (THVs), was recently published. Here, we present the design and rationale for the COMPARE-TAVI 2 trial comparing the Evolut FX+ self-expandable THV with the Sapien 3 Ultra Resilia balloon-expandable THV.</p><p><strong>Methods and analysis: </strong>In the COMPARE-TAVI 2 trial (ClinicalTrials.gov NCT06470022), patients will be randomized 1:1 between the THVs. The trial will test whether the Evolut FX+ self-expandable THV is noninferior to the Sapien 3 Ultra Resilia balloon-expandable THV in terms of the combined 1-year primary composite endpoint of all-cause mortality, stroke, moderate/severe total aortic regurgitation, or moderate/severe hemodynamic THV deterioration, according to VARC-3 criteria. If noninferiority is proven, superiority analyses may apply. Based on a power of 80%, alpha level of 0.05, 1-sided test, noninferiority margin of 4.5%, and expected event rate of 12%, the necessary sample size has been estimated to be 1,364 patients. Prespecified secondary endpoints, including long-term follow-up for 10 years, will also be investigated.</p><p><strong>Summary: </strong>The COMPARE-TAVI 2 will provide important information on the short- and long-term outcomes among patients treated with the Evolut FX+ self-expandable and the Sapien 3 Ultra Resilia balloon-expandable THVs.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107387"},"PeriodicalIF":3.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300787","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 : 2026-02-10DOI: 10.1016/j.ahj.2026.107378
Jason E Bloom, Jocasta Ball, Daniel Okyere, Aleksandr Voskoboinik, Luke P Dawson, Adam J Nelson, Mia Percival, Ben Meadley, Ross Salathiel, Tegwyn McManamny, Stuart Boggett, Riley Batchelor, Trent Hartshorne, Sonny Palmer, Christopher Reid, David Anderson, David Pilcher, Derek P Chew, David M Kaye, Ziad Nehme, Dion Stub
Background: Vasoactive medications constitute an integral component of the hemodynamic support strategy in patients with cardiogenic shock (CS). However, there is an emerging signal of harm associated with the commonly used catecholamine, epinephrine (adrenaline), when used in the treatment of CS. The PAramedic randomized trial of Noradrenaline (norepinephrine) versus Adrenaline in the management of patients with cardiogenic shock (PANDA) was therefore designed to determine if the initial treatment with norepinephrine, compared with epinephrine, improves outcomes in patients with CS.
Methods and design: The PANDA trial is a prehospital, open-label, single-blind, randomized controlled trial designed to assess the efficacy and safety of two commonly used catecholaminergic agents, norepinephrine and epinephrine, in the initial resuscitation of patients with suspected CS. Patients aged 18 years and older are eligible for recruitment by paramedics if there is clinical evidence of hypoperfusion, a measured systolic blood pressure of ≤90 mmHg despite adequate volume resuscitation with intravenous fluids, and the shock etiology is of a suspected cardiac cause (including cardiac arrest of an estimated duration of less than 30-minutes). Paramedics will randomize an anticipated 1,155 patients over an estimated 5-year period in a 1:1 ratio to receive an infusion of epinephrine or norepinephrine, which will be titrated to achieve a target systolic blood pressure of 100 mmHg. The primary efficacy outcome will be all-cause 28-day mortality. Recruitment commenced on February 28, 2024 and a total of 450 patients have been recruited thus far.
Implications: The PANDA trial will determine if norepinephrine, compared to epinephrine, for the initial hemodynamic support in CS improves outcomes. The results will help inform future treatment recommendations for the management of patients with CS.
{"title":"Design and rationale of a multicenter paramedic randomized trial of noradrenaline versus adrenaline in the initial management of patients with cardiogenic shock-The PANDA trial.","authors":"Jason E Bloom, Jocasta Ball, Daniel Okyere, Aleksandr Voskoboinik, Luke P Dawson, Adam J Nelson, Mia Percival, Ben Meadley, Ross Salathiel, Tegwyn McManamny, Stuart Boggett, Riley Batchelor, Trent Hartshorne, Sonny Palmer, Christopher Reid, David Anderson, David Pilcher, Derek P Chew, David M Kaye, Ziad Nehme, Dion Stub","doi":"10.1016/j.ahj.2026.107378","DOIUrl":"10.1016/j.ahj.2026.107378","url":null,"abstract":"<p><strong>Background: </strong>Vasoactive medications constitute an integral component of the hemodynamic support strategy in patients with cardiogenic shock (CS). However, there is an emerging signal of harm associated with the commonly used catecholamine, epinephrine (adrenaline), when used in the treatment of CS. The PAramedic randomized trial of Noradrenaline (norepinephrine) versus Adrenaline in the management of patients with cardiogenic shock (PANDA) was therefore designed to determine if the initial treatment with norepinephrine, compared with epinephrine, improves outcomes in patients with CS.</p><p><strong>Methods and design: </strong>The PANDA trial is a prehospital, open-label, single-blind, randomized controlled trial designed to assess the efficacy and safety of two commonly used catecholaminergic agents, norepinephrine and epinephrine, in the initial resuscitation of patients with suspected CS. Patients aged 18 years and older are eligible for recruitment by paramedics if there is clinical evidence of hypoperfusion, a measured systolic blood pressure of ≤90 mmHg despite adequate volume resuscitation with intravenous fluids, and the shock etiology is of a suspected cardiac cause (including cardiac arrest of an estimated duration of less than 30-minutes). Paramedics will randomize an anticipated 1,155 patients over an estimated 5-year period in a 1:1 ratio to receive an infusion of epinephrine or norepinephrine, which will be titrated to achieve a target systolic blood pressure of 100 mmHg. The primary efficacy outcome will be all-cause 28-day mortality. Recruitment commenced on February 28, 2024 and a total of 450 patients have been recruited thus far.</p><p><strong>Implications: </strong>The PANDA trial will determine if norepinephrine, compared to epinephrine, for the initial hemodynamic support in CS improves outcomes. The results will help inform future treatment recommendations for the management of patients with CS.</p><p><strong>Trial registration: </strong>ACTRN12621000805875.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107378"},"PeriodicalIF":3.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177368","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 : 2026-02-01Epub Date: 2025-09-16DOI: 10.1016/j.ahj.2025.09.009
Joshua Wong MBBS , Joel Smith MSc , Cheng Hwee Soh PhD , Erin Howden PhD , Jack S. Talbot PhD , Mark Nolan MBBS, PhD , Kristyn Whitmore BSN , Leah Wright PhD , Ashleigh-Georgia Sherriff BSMRes , Eswar Sivaraj MSc , Greg Wheeler MBBS , Kirsty Wiltshire MBBS , Phillip Campbell MB,ChB , Satish Ramkumar MBBS, BMedSci, MMed, PhD , Constantine Tam MBBS, MD , Thomas H. Marwick MBBS, PhD, MPH
Background
Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.
Objectives
The REDEEM (Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.
Methods
Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multidisciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO2peak) over 6 months.
Results
Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8 ± 6.8%), subclinical LV dysfunction was common (GLS 15.6 ± 2.1%) and 39% had evidence of functional impairment (VO2peak≤18ml/kg/min−1). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72–1.11], P = .360).
Conclusions
Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.
{"title":"Risk-guided disease management to prevent heart failure in adult cancer survivors of previous cardiotoxic cancer treatments: Baseline results of the REDEEM trial","authors":"Joshua Wong MBBS , Joel Smith MSc , Cheng Hwee Soh PhD , Erin Howden PhD , Jack S. Talbot PhD , Mark Nolan MBBS, PhD , Kristyn Whitmore BSN , Leah Wright PhD , Ashleigh-Georgia Sherriff BSMRes , Eswar Sivaraj MSc , Greg Wheeler MBBS , Kirsty Wiltshire MBBS , Phillip Campbell MB,ChB , Satish Ramkumar MBBS, BMedSci, MMed, PhD , Constantine Tam MBBS, MD , Thomas H. Marwick MBBS, PhD, MPH","doi":"10.1016/j.ahj.2025.09.009","DOIUrl":"10.1016/j.ahj.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.</div></div><div><h3>Objectives</h3><div>The REDEEM (<em>Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents</em>) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.</div></div><div><h3>Methods</h3><div>Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multidisciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO<sub>2</sub>peak) over 6 months.</div></div><div><h3>Results</h3><div>Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8 ± 6.8%), subclinical LV dysfunction was common (GLS 15.6 ± 2.1%) and 39% had evidence of functional impairment (VO<sub>2</sub>peak≤18ml/kg/min<sup>−1</sup>). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72–1.11], <em>P</em> = .360).</div></div><div><h3>Conclusions</h3><div>Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.</div></div><div><h3>Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT04962711, <span><span>https://www.clinicaltrials.gov/study/NCT04962711</span><svg><path></path></svg></span></div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107277"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084960","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 : 2026-02-01Epub Date: 2025-08-26DOI: 10.1016/j.ahj.2025.08.017
Nkiru Osude MD, MS , Christopher B. Granger MD , Rebecca Young MS , Hussein Al-Khalidil PhD , Kimberly Ward MPH , Monica Leyva MHARCIS , Cameron Lambert MD , Michael Tillery , Albert Lin MD , Rohit Mehta MD , Misra Satish MD , Graham Peigh MD, MSc , Austin Wright , Laurence M. Epstein MD , Carina Blomstrom Lundqvist MD, PhD , Jonathn P. Piccini MD, MHSc , M. Rizwan Sohail MD , Sean D. Pokorney MD, MBA
Background
Cardiac implantable electronic device (CIED) infections are a growing concern due to their associated high morbidity, mortality, and healthcare costs. Current guidelines given complete device and lead removal for CIED infection a class I recommendation, yet adherence to these guidelines is low with delays in extraction associated with poor adverse clinical events.
Obejctives
To determine the effect of implementation of quality improvement (QI) interventions on patients with CIED infections, including rates of extraction and time to extraction.
Methods
This is a prospective interventional study conducted across 3 U.S. health systems that employs QI interventions aimed at increasing early identification of CIED infections. The study will have a retrospective review of treatment of CIED infection patients, followed by a 6-month QI intervention period, and a 12-month prospective data collection period after the QI intervention. Eligible patients will have a CIED and a presumed CIED infection (pocket or systemic infection). The primary endpoints are the change in the number of extractions performed for CIED infections and the time to extraction during the study.
Conclusions
The REview and improvement of Cardiac implanTable device InFection qualitY initiative (RECTIFY) is a multi-center demonstration project aimed to identify and address health system-wide barriers to timely diagnosis and guideline-driven management of CIED infections.
Trial Registration: The trial was registered with the U.S. National Library of Medicine at the National Institutes of Health (NCT05471973).
{"title":"REview and improvement of cardiac implanTable device Infection management qualitY initiative (RECTIFY): Rationale and design for a cardiac implantable electronic device infection quality initiative demonstration project","authors":"Nkiru Osude MD, MS , Christopher B. Granger MD , Rebecca Young MS , Hussein Al-Khalidil PhD , Kimberly Ward MPH , Monica Leyva MHARCIS , Cameron Lambert MD , Michael Tillery , Albert Lin MD , Rohit Mehta MD , Misra Satish MD , Graham Peigh MD, MSc , Austin Wright , Laurence M. Epstein MD , Carina Blomstrom Lundqvist MD, PhD , Jonathn P. Piccini MD, MHSc , M. Rizwan Sohail MD , Sean D. Pokorney MD, MBA","doi":"10.1016/j.ahj.2025.08.017","DOIUrl":"10.1016/j.ahj.2025.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac implantable electronic device (CIED) infections are a growing concern due to their associated high morbidity, mortality, and healthcare costs. Current guidelines given complete device and lead removal for CIED infection a class I recommendation, yet adherence to these guidelines is low with delays in extraction associated with poor adverse clinical events.</div></div><div><h3>Obejctives</h3><div>To determine the effect of implementation of quality improvement (QI) interventions on patients with CIED infections, including rates of extraction and time to extraction.</div></div><div><h3>Methods</h3><div>This is a prospective interventional study conducted across 3 U.S. health systems that employs QI interventions aimed at increasing early identification of CIED infections. The study will have a retrospective review of treatment of CIED infection patients, followed by a 6-month QI intervention period, and a 12-month prospective data collection period after the QI intervention. Eligible patients will have a CIED and a presumed CIED infection (pocket or systemic infection). The primary endpoints are the change in the number of extractions performed for CIED infections and the time to extraction during the study.</div></div><div><h3>Conclusions</h3><div>The REview and improvement of Cardiac implanTable device InFection qualitY initiative (RECTIFY) is a multi-center demonstration project aimed to identify and address health system-wide barriers to timely diagnosis and guideline-driven management of CIED infections.</div><div><strong>Trial Registration:</strong> The trial was registered with the U.S. National Library of Medicine at the National Institutes of Health (NCT05471973).</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107264"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939530","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 : 2026-02-01Epub Date: 2025-11-03DOI: 10.1016/j.ahj.2025.107295
Gilles Montalescot MD-PhD , Leonardo Bolognese MD , Stanislaw Bartus MD , Angel Cequier-Fillat MD , Holger Thiele MD , François Mach MD , J. Wouter Jukema MD , Emile Ferrari MD-PhD , Géraud Souteyrand MD , Claire Bouleti MD-PhD , Grégoire Range MD , Marco Chioccioli MD , Andréa Picchi MD , Laure Batias-Moreau MD , Giovanni Esposito MD , Nassim Braik MD , Nassim Redjimi MD , Benjamin Duband MD , Paul Guedeney MD-PhD , Michel Zeitouni MD-PhD , Eric Vicaut MD-PhD
Rationale
PCSK9 inhibitors are currently recommended as third-line therapy for post–myocardial infarction (MI) patients, added to high-dose statin, ezetimibe, and potentially bempedoic acid when the LDL-C target of <55 mg/dL is not achieved. These guideline-driven indications result in delayed initiation of PCSK9 inhibitors, potentially missing the opportunity for benefit during the acute phase. Recent studies have demonstrated that early PCSK9 inhibition promotes anti-inflammatory effects and plaque stabilization, suggesting a potential role early in MI management.
Methods
The AMUNDSEN trial is a randomized, international, phase IV study using a PROBE (Prospective Randomized Open, Blinded Endpoint) design to evaluate the effects of early PCSK9 inhibition in high-risk acute MI patients undergoing percutaneous coronary intervention (PCI). A total of 2,166 patients were enrolled, including those with ST-elevation MI undergoing primary PCI and those with non–ST-elevation MI with an indication for PCI, all presenting with at least 1 high-risk clinical characteristic. Patients were randomized to receive either immediate evolocumab prior to PCI alongside standard care or standard care alone. The primary objective is to achieve both a ≥ 50% reduction in LDL-C from baseline and a target LDL-C < 55 mg/dL at 12 months. The main clinical objective is to assess the composite of all-cause death or unplanned hospitalization for a cardiovascular (CV) reason at 12 months.
Current status
Enrollment and randomization are complete. Lipid and clinical follow-up are ongoing. Results from this study will clarify the lipid-lowering efficacy and clinical impact of early evolocumab initiation in the acute MI setting.
Conclusion
The AMUNDSEN trial will provide critical insights into the potential benefits of early PCSK9 inhibition in high-risk MI patients undergoing PCI.
{"title":"Evolocumab before percutaneous coronary intervention for acute myocardial infarction: Design of the AMUNDSEN trial","authors":"Gilles Montalescot MD-PhD , Leonardo Bolognese MD , Stanislaw Bartus MD , Angel Cequier-Fillat MD , Holger Thiele MD , François Mach MD , J. Wouter Jukema MD , Emile Ferrari MD-PhD , Géraud Souteyrand MD , Claire Bouleti MD-PhD , Grégoire Range MD , Marco Chioccioli MD , Andréa Picchi MD , Laure Batias-Moreau MD , Giovanni Esposito MD , Nassim Braik MD , Nassim Redjimi MD , Benjamin Duband MD , Paul Guedeney MD-PhD , Michel Zeitouni MD-PhD , Eric Vicaut MD-PhD","doi":"10.1016/j.ahj.2025.107295","DOIUrl":"10.1016/j.ahj.2025.107295","url":null,"abstract":"<div><h3>Rationale</h3><div>PCSK9 inhibitors are currently recommended as third-line therapy for post–myocardial infarction (MI) patients, added to high-dose statin, ezetimibe, and potentially bempedoic acid when the LDL-C target of <55 mg/dL is not achieved. These guideline-driven indications result in delayed initiation of PCSK9 inhibitors, potentially missing the opportunity for benefit during the acute phase. Recent studies have demonstrated that early PCSK9 inhibition promotes anti-inflammatory effects and plaque stabilization, suggesting a potential role early in MI management.</div></div><div><h3>Methods</h3><div>The AMUNDSEN trial is a randomized, international, phase IV study using a PROBE (Prospective Randomized Open, Blinded Endpoint) design to evaluate the effects of early PCSK9 inhibition in high-risk acute MI patients undergoing percutaneous coronary intervention (PCI). A total of 2,166 patients were enrolled, including those with ST-elevation MI undergoing primary PCI and those with non–ST-elevation MI with an indication for PCI, all presenting with at least 1 high-risk clinical characteristic. Patients were randomized to receive either immediate evolocumab prior to PCI alongside standard care or standard care alone. The primary objective is to achieve both <em>a</em> ≥ 50% reduction in LDL-C from baseline and a target LDL-C < 55 mg/dL at 12 months. The main clinical objective is to assess the composite of all-cause death or unplanned hospitalization for a cardiovascular (CV) reason at 12 months.</div></div><div><h3>Current status</h3><div>Enrollment and randomization are complete. Lipid and clinical follow-up are ongoing. Results from this study will clarify the lipid-lowering efficacy and clinical impact of early evolocumab initiation in the acute MI setting.</div></div><div><h3>Conclusion</h3><div>The AMUNDSEN trial will provide critical insights into the potential benefits of early PCSK9 inhibition in high-risk MI patients undergoing PCI.</div></div><div><h3>Clinical trial registration</h3><div>NCT (clinicaltrials.gov): 04951856 - EUCT number: 2024-518195-31-00.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107295"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450581","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 : 2026-02-01Epub Date: 2025-09-08DOI: 10.1016/j.ahj.2025.09.003
Giuseppe Di Gioia MD , Armando Ferrera MD , Viviana Maestrini MD, PhD , Sara Monosilio MD, PhD , Federica Mango MD , Davide Ortolina MD , Antonio Pelliccia MD , Maria Rosaria Squeo MD
Background
Athlete's heart, characterized by cardiac chambers adaptations to exercise has some diagnostic overlaps with dilated cardiomyopathy (DCM). In the setting of differential diagnosis, myocardial work indexes (MWI), afterload-independent tool, could be helpful to identify early subclinical alterations. The aim of our study was to assess the utility of MWI in athletes with mildly reduced left ventricular ejection fraction (LVEF).
Methods
We enrolled 306 Olympic athletes (55.5% males) practicing endurance and mixed disciplines, mean age 26.3 ± 4.3 years old, who underwent cardio-pulmonary exercise test (CPET) and transthoracic echocardiogram. Athletes were divided in those with lower (<55%) and normal LVEF (≥55%). Strain rate and MWI were performed and the following parameters collected: global longitudinal strain, global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).
Results
Twenty-seven athletes had LVEF<55% (mean 51.5% ± 2.6%). Athletes with EF < 55% presented larger LVEDVi (79.1 ± 15.7 vs. 73.2 ± 13.8 mm/m2, P = .035), LV mass (P = .049) and LAVi (P = .016). No differences were found in GWI (1,757.9 ± 242 vs 1,839.8 ± 255.6 mmHg%, P = .112), GCW (2,121.6 ± 269.3 vs. 2,209.3 ± 281 mmHg%, P = .124), GWW (95.2 ± 40.7 vs. 87.1 ± 47.4 mmHg%, P = .394) or GWE (95.2 ± 1.7 vs. 95.7 ± 2%, P = .181). At CPET, in those with EF < 55%, higher Watts (340.0 ± 83.7 vs. 291.6 ± 84.8, P = .004), VO2 mL/min/Kg (51.0 ± 13.5 vs. 46.0 ± 10.1, P = .020) and O2 pulse (23.5 ± 4.6 vs. 21 ± 5.3, P = .020) were found.
Conclusions
MWI could be used as additive tool to characterize the physiologic nature of mildly reduced EF of endurance athletes, presenting with better functional parameters but preserved MWI values. MWI may be helpful in differential diagnosis of athlete’s heart from DCM.
{"title":"Myocardial work indexes in elite athletes: An emerging echocardiographic tool to confirm physiologic cardiac remodeling in elite athletes with mildly reduced systolic function","authors":"Giuseppe Di Gioia MD , Armando Ferrera MD , Viviana Maestrini MD, PhD , Sara Monosilio MD, PhD , Federica Mango MD , Davide Ortolina MD , Antonio Pelliccia MD , Maria Rosaria Squeo MD","doi":"10.1016/j.ahj.2025.09.003","DOIUrl":"10.1016/j.ahj.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Athlete's heart, characterized by cardiac chambers adaptations to exercise has some diagnostic overlaps with dilated cardiomyopathy (DCM). In the setting of differential diagnosis, myocardial work indexes (MWI), afterload-independent tool, could be helpful to identify early subclinical alterations. The aim of our study was to assess the utility of MWI in athletes with mildly reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods</h3><div>We enrolled 306 Olympic athletes (55.5% males) practicing endurance and mixed disciplines, mean age 26.3 ± 4.3 years old, who underwent cardio-pulmonary exercise test (CPET) and transthoracic echocardiogram. Athletes were divided in those with lower (<55%) and normal LVEF (≥55%). Strain rate and MWI were performed and the following parameters collected: global longitudinal strain, global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).</div></div><div><h3>Results</h3><div>Twenty-seven athletes had LVEF<55% (mean 51.5% ± 2.6%). Athletes with EF < 55% presented larger LVEDVi (79.1 ± 15.7 vs. 73.2 ± 13.8 mm/m2, <em>P</em> = .035), LV mass (<em>P</em> = .049) and LAVi (<em>P</em> = .016). No differences were found in GWI (1,757.9 ± 242 vs 1,839.8 ± 255.6 mmHg%, <em>P</em> = .112), GCW (2,121.6 ± 269.3 vs. 2,209.3 ± 281 mmHg%, <em>P</em> = .124), GWW (95.2 ± 40.7 vs. 87.1 ± 47.4 mmHg%, <em>P</em> = .394) or GWE (95.2 ± 1.7 vs. 95.7 ± 2%, <em>P</em> = .181). At CPET, in those with EF < 55%, higher Watts (340.0 ± 83.7 vs. 291.6 ± 84.8, <em>P</em> = .004), VO<sub>2</sub> mL/min/Kg (51.0 ± 13.5 vs. 46.0 ± 10.1, <em>P</em> = .020) and O2 pulse (23.5 ± 4.6 vs. 21 ± 5.3, <em>P</em> = .020) were found.</div></div><div><h3>Conclusions</h3><div>MWI could be used as additive tool to characterize the physiologic nature of mildly reduced EF of endurance athletes, presenting with better functional parameters but preserved MWI values. MWI may be helpful in differential diagnosis of athlete’s heart from DCM.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107271"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032573","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 : 2026-02-01Epub Date: 2025-09-12DOI: 10.1016/j.ahj.2025.09.005
Ulf Landmesser MD , Carsten Skurk MD , Paulus Kirchhof MD , Thorsten Lewalter MD , Johannes Hartung MD , Andi Rroku MD , Burkert Pieske MD , Johannes Brachmann MD , Ibrahim Akin MD , Claudius Jacobshagen MD , Benjamin Meder MD , Andreas Zeiher MD , Stefan D. Anker MD , Holger Thiele MD , Stefan Blankenberg MD , Steffen Massberg MD , Heribert Schunkert MD , Norbert Frey MD , Alexander Joost MD , Martin Bergmann MD , Ingo Eitel MD
Background
Percutaneous catheter‐based left atrial appendage (LAA) closure is a potential alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF). The effectiveness and safety of LAA closure in patients with AF at high risk of stroke (CHA2DS2‐VASc Score ≥2) and high risk of bleeding compared to best medical care including a nonvitamin K antagonist oral anticoagulant [NOAC] when considered eligible is not known.
Methods/Design
The prospective, multicenter, randomized clinical Left atrial appendage CLOSURE in patients with Atrial Fibrillation at high risk of stroke and bleeding compared to medical therapy (CLOSURE-AF) trial compared catheter-based LAA closure to best medical care (including NOAC therapy if considered eligible) in patients with AF at high risk of stroke and with either a history of bleeding or a high estimated bleeding risk (HASBLED ≥ 3). The primary endpoint is time to a composite of first stroke (ischemic or hemorrhagic), systemic embolism, cardiovascular or unexplained death or major bleeding (Bleeding Academic Research Consortium 3-5). Secondary outcomes include components of the primary outcome and total mortality. The primary efficacy analysis will be performed in the intention‐to‐treat population using Cox regression models for noninferiority with an option to test for superiority once noninferiority has been proven.
Results
The first patient in the CLOSURE-AF trial was enrolled in March 2018. By April 2025 the complete study cohort of n = 912 patients had been enrolled in 42 sites.
Conclusion
CLOSURE-AF will contribute evidence on the effectiveness and safety of LAA occlusion compared to optimal medical therapy in patients with AF at high risk of stroke and bleeding. The trial results will help to define the clinical use of catheter-based LAA closure in the future.
{"title":"Catheter-based left atrial appendage CLOSURE in patients with atrial fibrillation at high risk of stroke and bleeding as compared to best medical therapy: Rationale and design of the prospective randomized CLOSURE-AF trial","authors":"Ulf Landmesser MD , Carsten Skurk MD , Paulus Kirchhof MD , Thorsten Lewalter MD , Johannes Hartung MD , Andi Rroku MD , Burkert Pieske MD , Johannes Brachmann MD , Ibrahim Akin MD , Claudius Jacobshagen MD , Benjamin Meder MD , Andreas Zeiher MD , Stefan D. Anker MD , Holger Thiele MD , Stefan Blankenberg MD , Steffen Massberg MD , Heribert Schunkert MD , Norbert Frey MD , Alexander Joost MD , Martin Bergmann MD , Ingo Eitel MD","doi":"10.1016/j.ahj.2025.09.005","DOIUrl":"10.1016/j.ahj.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous catheter‐based left atrial appendage (LAA) closure is a potential alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF). The effectiveness and safety of LAA closure in patients with AF at high risk of stroke (CHA2DS2‐VASc Score ≥2) and high risk of bleeding compared to best medical care including a nonvitamin K antagonist oral anticoagulant [NOAC] when considered eligible is not known.</div></div><div><h3>Methods/Design</h3><div>The prospective, multicenter, randomized clinical Left atrial appendage CLOSURE in patients with Atrial Fibrillation at high risk of stroke and bleeding compared to medical therapy (CLOSURE-AF) trial compared catheter-based LAA closure to best medical care (including NOAC therapy if considered eligible) in patients with AF at high risk of stroke and with either a history of bleeding or a high estimated bleeding risk (HASBLED ≥ 3). The primary endpoint is time to a composite of first stroke (ischemic or hemorrhagic), systemic embolism, cardiovascular or unexplained death or major bleeding (Bleeding Academic Research Consortium 3-5). Secondary outcomes include components of the primary outcome and total mortality. The primary efficacy analysis will be performed in the intention‐to‐treat population using Cox regression models for noninferiority with an option to test for superiority once noninferiority has been proven.</div></div><div><h3>Results</h3><div>The first patient in the CLOSURE-AF trial was enrolled in March 2018. By April 2025 the complete study cohort of <em>n</em> = 912 patients had been enrolled in 42 sites.</div></div><div><h3>Conclusion</h3><div>CLOSURE-AF will contribute evidence on the effectiveness and safety of LAA occlusion compared to optimal medical therapy in patients with AF at high risk of stroke and bleeding. The trial results will help to define the clinical use of catheter-based LAA closure in the future.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NCT03463317</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107273"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063412","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 : 2026-02-01Epub Date: 2025-10-02DOI: 10.1016/j.ahj.2025.107284
Ahmed Abdelaziz MD , Shrouk Ramadan MD , Mohammed Tarek Hasan MD , Muhammad Desouky MD , Karim Atta MBBS , Abdelrahman Hafez MD , Mahmoud Mohamed Shams MD , Ahmed Helmi MD , Rahma AbdElfattah Ibrahim MD , Ahmed Sobhy MD , Rehab Adel Diab MD , Fayed Mohamed Rzk MD , Ahmed Farid Gadelmawla MD , Ziad Mohsen Alenna MD , Mohamed Abdelaziz MD , Mohamed Nabil Hamouda MD , Noha Hammad MD , Daniel Lorenzatti MD , Carl J Lavie MD , Leandro Slipczuk MD, PhD , Gregg W Stone MD
Complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease reduces major adverse cardiac events (MACE) compared with incomplete revascularization, although whether survival is improved is uncertain. For this systematic review and meta-analysis, all randomized trials of complete vs incomplete revascularization in patients with acute MI without cardiogenic shock were identified from PubMed, Scopus, Web of Science, and Cochrane Library databases from inception to December 31, 2024. The primary and major secondary endpoints were MACE and all-cause mortality derived from reconstructed time-to-event individual-patient-data from published Kaplan-Meier curves. Additional outcomes included cardiovascular mortality, MI, and unplanned repeat revascularizations. Outcomes were expressed as hazard ratios with 95% confidence intervals. This study was registered with the PROSPERO (number, CRD42023415428). A total of 9 randomized trials with 9,658 patients (86.8% with STEMI) were identified among whom 4,671 (48.4%) patients had complete revascularization. Patients with complete revascularization had a lower 5-year risk of MACE (HR: 0.59, 95% CI: 0.54 to 0.66, P < .001) compared with incomplete revascularization. Complete revascularization was also associated with lower 5-year risks of all-cause mortality (HR: 0.64, 95% CI: 0.56 to 0.72, P < .001), cardiovascular mortality (HR: 0.82, 95% CI: 0.71 to 0.95, P = .008), MI (HR: 0.69, 95% CI: 0.55 to 0.87, P < .001), and unplanned repeat revascularizations (HR: 0.62, 95% CI: 0.54 to 0.71, P < .001). Complete revascularization results in lower risks of all-cause and cardiovascular mortality, MI, unplanned repeat revascularizations and MACE in patients with acute MI and multivessel disease. These results support current guidelines recommending CR in hemodynamically stable patients with STEMI, emphasizing that this approach may improve survival.
与不完全血运重建术相比，st段抬高型心肌梗死（STEMI）和多血管疾病患者的完全血运重建术可减少主要不良心脏事件（MACE），尽管生存率是否提高尚不确定。在这项系统评价和荟萃分析中，从PubMed、Scopus、Web of Science和Cochrane Library数据库中确定了从开始到2024年12月31日的急性心肌梗死无心源性休克患者的完全与不完全血运重建术的所有随机试验。主要终点和次要终点是MACE和全因死亡率，这些全因死亡率来自于已发表的Kaplan-Meier曲线中重构的个体患者数据。其他结果包括心血管死亡率、心肌梗死和计划外重复血运重建术。结果以95%置信区间的风险比表示。本研究已在PROSPERO注册（编号：CRD42023415428）。共有9项随机试验，9658例患者（86.8%）被确定为STEMI，其中4671例（48.4%）患者完全血运重建术。完全血运重建术患者发生MACE的5年风险较低(HR: 0.59, 95% CI: 0.54 ~ 0.66, p
{"title":"Complete revascularization in patients with acute myocardial infarction and multivessel disease: Pooled analysis of Kaplan-Meier-derived individual-patient-data","authors":"Ahmed Abdelaziz MD , Shrouk Ramadan MD , Mohammed Tarek Hasan MD , Muhammad Desouky MD , Karim Atta MBBS , Abdelrahman Hafez MD , Mahmoud Mohamed Shams MD , Ahmed Helmi MD , Rahma AbdElfattah Ibrahim MD , Ahmed Sobhy MD , Rehab Adel Diab MD , Fayed Mohamed Rzk MD , Ahmed Farid Gadelmawla MD , Ziad Mohsen Alenna MD , Mohamed Abdelaziz MD , Mohamed Nabil Hamouda MD , Noha Hammad MD , Daniel Lorenzatti MD , Carl J Lavie MD , Leandro Slipczuk MD, PhD , Gregg W Stone MD","doi":"10.1016/j.ahj.2025.107284","DOIUrl":"10.1016/j.ahj.2025.107284","url":null,"abstract":"<div><div>Complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease reduces major adverse cardiac events (MACE) compared with incomplete revascularization, although whether survival is improved is uncertain. For this systematic review and meta-analysis, all randomized trials of complete vs incomplete revascularization in patients with acute MI without cardiogenic shock were identified from PubMed, Scopus, Web of Science, and Cochrane Library databases from inception to December 31, 2024. The primary and major secondary endpoints were MACE and all-cause mortality derived from reconstructed time-to-event individual-patient-data from published Kaplan-Meier curves. Additional outcomes included cardiovascular mortality, MI, and unplanned repeat revascularizations. Outcomes were expressed as hazard ratios with 95% confidence intervals. This study was registered with the PROSPERO (number, CRD42023415428). A total of 9 randomized trials with 9,658 patients (86.8% with STEMI) were identified among whom 4,671 (48.4%) patients had complete revascularization. Patients with complete revascularization had a lower 5-year risk of MACE (HR: 0.59, 95% CI: 0.54 to 0.66, <em>P</em> < .001) compared with incomplete revascularization. Complete revascularization was also associated with lower 5-year risks of all-cause mortality (HR: 0.64, 95% CI: 0.56 to 0.72, <em>P</em> < .001), cardiovascular mortality (HR: 0.82, 95% CI: 0.71 to 0.95, <em>P</em> = .008), MI (HR: 0.69, 95% CI: 0.55 to 0.87, <em>P</em> < .001), and unplanned repeat revascularizations (HR: 0.62, 95% CI: 0.54 to 0.71, <em>P</em> < .001). Complete revascularization results in lower risks of all-cause and cardiovascular mortality, MI, unplanned repeat revascularizations and MACE in patients with acute MI and multivessel disease. These results support current guidelines recommending CR in hemodynamically stable patients with STEMI, emphasizing that this approach may improve survival.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107284"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228615","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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