Clinical Cardiology最新文献

{"title":"Incorporating Inflammation Biomarker-Driven Multivariate Predictive Model for Coronary Microcirculatory Dysfunction in Acute Myocardial Infarction Following Emergency Percutaneous Coronary Intervention","authors":"Zhuoya Yao,&nbsp;Bin Ding,&nbsp;Jun Wang,&nbsp;Shaohuan Qian,&nbsp;Xilong Song,&nbsp;Yao Li,&nbsp;Siyu Ding,&nbsp;Hongju Wang,&nbsp;Miaonan Li","doi":"10.1002/clc.70032","DOIUrl":"10.1002/clc.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite patients with successful revascularization as evidenced by angiographic findings, inadequate clinical management of coronary microcirculatory dysfunction (CMD) may result in preventable adverse outcomes. Therefore, it is imperative to use a multimodal data‑driven predictive model for the occurrence of CMD in patients with acute myocardial infarction (AMI) following emergency percutaneous coronary intervention (PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective case−control analysis was conducted on a cohort of 77 patients with AMI who underwent PCI. The most informative predictors were selected for the predictive model through the application of LASSO analysis and multi-factor logistic regression. The diagnosis of CMD is based on findings from cardiac magnetic resonance (CMR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on the findings from LASSO analysis and multi-factor logistic regression, variables including sex, neutrophil-to-lymphocyte ratio (NLR), Gensini score, and diabetes mellitus were identified as independent predictors for the development of CMD in AMI patients who underwent emergency PCI. The predictive model was evaluated using bootstrap self-sampling 500 times. The resulting predictive model demonstrated an AUC value of 0.897 (95% CI: 0.827−0.958). The calibration curves exhibited good concordance between the predictions generated by the model and the CMR analysis. Furthermore, decision curve analysis revealed that the predictive model provided valuable clinical benefit in predicting CMD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The multivariate predictive model, constructed using readily available clinical variables in patients with AMI who underwent PCI, demonstrates satisfactory predictability for identifying comorbid CMD, thereby facilitating the identification of high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The High-Sensitivity HEART Pathway Safely Reduces Hospitalizations Regardless of Sex or Race in a Multisite Prospective US Cohort","authors":"Campbell J. Veasey,&nbsp;Anna C. Snavely,&nbsp;Zechariah L. Kearns,&nbsp;Nicklaus P. Ashburn,&nbsp;Tara Hashemian,&nbsp;Simon A. Mahler","doi":"10.1002/clc.70027","DOIUrl":"https://doi.org/10.1002/clc.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The high-sensitivity HEART pathway (hs-HP) risk stratifies emergency department (ED) patients with chest pain. It is unknown if its safety and effectiveness vary by sex or race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a subgroup analysis of the hs-HP implementation study, a pre−post interrupted time series at five US EDs. The pre-implementation period (January 2019 to April 2020) utilized the traditional HEART pathway with contemporary troponin (Siemens) and the post-implementation period (November 2020 to February 2022) used the hs-HP using hs-cTnI (Beckman Coulter). Patients were risk-stratified using the hs-HP to rule-out, observation, and rule-in groups. Safety and effectiveness outcomes were 30-day all-cause mortality or myocardial infarction (MI) and 30-day hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-six thousand and one hundred twenty-six patients were accrued (12 317 pre- and 13 809 post-implementation), of which 35.3% were non-White and 52.7% were female. Among 9703 patients with complete hs-HP assessments, 48.6% of White and 55.4% of non-White patients were ruled-out (<i>p</i> &lt; 0.001). Additionally, 47.3% of males and 54.4% of females were ruled-out (<i>p</i> &lt; 0.001). Among rule-out patients, 0.3% of White versus 0.3% of non-White patients (<i>p</i> = 0.98) and 0.3% of females versus males 0.3% (<i>p</i> = 0.90) experienced 30-day death or MI. Post-implementation, 30-day hospitalization decreased 17.2% among White patients (aOR 0.49, 95% CI: 0.45−0.52), 14.1% among non-White patients (aOR 0.53, 95% CI: 0.48−0.59), 15.6% among females (aOR 0.50, 95% CI: 0.46−0.54), and 16.6% among males (aOR 0.51, 95% CI: 0.47−0.56). The interactions for 30-day hospitalization between hs-HP implementation and race (<i>p</i> = 0.10) and sex (<i>p</i> = 0.69) were not significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The hs-HP safely decreases 30-day hospitalizations regardless of sex or race. However, it classifies more non-White patients and women to the rule-out group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Inflammation in Early Left Ventricular Thrombus Formation Following ST-Elevation Myocardial Infarction—A Matched Case-Control Study","authors":"Batia Litmanowicz,&nbsp;Moran Gvili Perelman,&nbsp;Michal Laufer-Perl,&nbsp;Yan Topilsky,&nbsp;Shmuel Banai,&nbsp;Yacov Shacham,&nbsp;Shafik Khoury","doi":"10.1002/clc.70031","DOIUrl":"https://doi.org/10.1002/clc.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is limited data on the association between inflammation and the formation of early left ventricular thrombus (LVT) following ST-elevation myocardial infarction (STEMI). This study aimed to explore the predictive value of several inflammatory biomarkers for LVT formation following STEMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Our cohort included 2534 consecutive patients admitted to the cardiac intensive care unit (CICU) with STEMI. The final analysis included 51 patients with LVT and 102 patients without LVT, matched for age, sex, anterior infarct and ejection fraction. Upon admission, patients with LVT had higher white blood cell counts (WBC) (12.8 ± 7 vs. 12.4 ± 4 ×10³/µL, <i>p</i> = 0.01), higher absolute neutrophil counts (10.5 ± 4 vs. 8.6 ± 4 ×10³/µL, <i>p</i> = 0.003), neutrophil-to-lymphocyte ratio (8.2 ± 6 vs. 4.8 ± 4, <i>p</i> = 0.04), and C-reactive protein (CRP) levels (35.9 ± 62 vs. 18.6 ± 40 mg/L, <i>p</i> = 0.04). Peak values for WBC and CRP were also higher in the LVT group (17.8 ± 8 vs. 14.6 ± 5 ×10³/µL, <i>p</i> = 0.003 and 95.8 ± 82 vs. 64.2 ± 76 mg/L, <i>p</i> = 0.02, respectively). In univariate regression analysis, WBC upon admission (OR: 1.12, 95% CI: 1.02–1.21, <i>p</i> = 0.02), peak WBC (OR: 1.09, 95% CI: 1.02–1.17, <i>p</i> = 0.009), neutrophil count upon admission (OR: 1.15, 95% CI: 1.04–1.26, <i>p</i> = 0.004), and peak CRP (OR: 1.01, 95% CI: 1–1.01, <i>p</i> = 0.03) predicted LVT formation, which was also evident in multivariate regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>WBC and neutrophil counts upon admission, as well as peak WBC and CRP, have additional predictive value for LVT formation following STEMI, beyond classical risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Overweight/Obesity Metabolic Phenotypes Defined by Two Criteria of Metabolic Abnormality and Cardiovascular Diseases: A Cross-Sectional Analysis in a Chinese Population","authors":"Yue Qiu,&nbsp;Shujin Fan,&nbsp;Jing Liu,&nbsp;Xiaodan He,&nbsp;Tianxin Zhu,&nbsp;Li Yan,&nbsp;Meng Ren","doi":"10.1002/clc.70020","DOIUrl":"https://doi.org/10.1002/clc.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Obesity/overweight and metabolic anomalies are known to be associated with elevated cardiovascular disease (CVD) risk. However, there is a paucity of research exploring the association between different body weights, varying metabolic statuses, and the occurrence of CVD in the Chinese population. Thus, we performed this study to explore the relation between different metabolic overweight/obesity phenotypes and the prevalence of CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from 9075 participants in the Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study. Participants were classified into four metabolic phenotypes based on their metabolic status and obesity/overweight status. Regression analysis was used to evaluate the relationship between CVD and different groups. Additionally, we conducted a subgroup analysis to further explore the relationship between CVD and different metabolic abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to metabolically healthy non-overweight/obesity (MHNO) individuals, both overweight/obesity and metabolic anomalies were positively associated with CVD prevalence. Among other metabolically unhealthy and overweight/obesity phenotypes, metabolically healthy overweight/obesity (MHO) generally exhibited a comparatively lower association with CVD. In the elderly, high waist circumference was significantly associated with CVD, rather than body weight. Further analysis revealed that hypertension had the strongest association with CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elderly individuals should place more emphasis on managing their waist circumference rather than only on BMI. CVD prevention should focus on both body weight management and treatment of metabolic diseases, with particular emphasis on antihypertensive therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors","authors":"Shir Frydman,&nbsp;Ophir Freund,&nbsp;Haytham Abu katash,&nbsp;Daniel Rimbrot,&nbsp;Shmuel Banai,&nbsp;Yacov Shacham","doi":"10.1002/clc.70002","DOIUrl":"10.1002/clc.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute kidney injury (AKI) is a common and serious complication of ST-elevation myocardial infarction (STEMI). AKI and chronic kidney disease (CKD) are highly heterogeneous, leaving a wide gap between them. Therefore, the term acute kidney disease (AKD) was implemented, describing prolonged renal injury between 7 and 90 days. We aimed to evaluate the prevalence and predictors of AKD among STEMI patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included 2940 consecutive patients admitted with STEMI between 2008 and 2022. Renal function was assessed upon admission and routinely thereafter. Renal outcomes were evaluated according to KDIGO criteria, with AKD defined as persistent renal injury of between 7 and 90 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and fifty-two subjects with STEMI and AKI were included; of them, 117 (46%) developed AKD. Among baseline CKD patients, higher rates of AKD were observed (60% vs. 46%). KDIGO index ≥ 2 was an independent predictor for AKD in in subjects without baseline CKD (AOR 2.63, 95% CI 1.07−6.53). In subjects with baseline CKD, older age and higher creatinine were independent predictors for AKD. Subjects with AKD had a higher 1-year mortality rate (HR 3.39, 95% CI 1.71−6.72, <i>p</i> &lt; 0.01). This trend was mainly driven by the CKD subpopulation where higher mortality rates for AKD on CKD were observed (HR 5.26, 95% CI 1.83−15.1, <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AKD is common among STEMI patients with AKI. The presence of CKD and higher KDIGO stage should prompt strict monitoring for early diagnosis, treatment, and prevention of renal function deterioration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-Analysis Comparing Oral Anticoagulant Monotherapy Versus Dual Antithrombotic Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease","authors":"Mushood Ahmed,&nbsp;Areeba Ahsan,&nbsp;Aimen Shafiq,&nbsp;Raheel Ahmed,&nbsp;Mahboob Alam,&nbsp;Pierre Sabouret,&nbsp;Jamal S. Rana,&nbsp;Gregg C. Fonarow","doi":"10.1002/clc.70026","DOIUrl":"10.1002/clc.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral anticoagulants (OACs) are routinely used for the management of atrial fibrillation (AF) while antiplatelet agents are used in coronary artery disease (CAD). However, data regarding the comparative clinical outcomes of OAC monotherapy versus dual antithrombotic therapy (anticoagulant plus antiplatelet agent) in patients with AF and stable CAD are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search of major databases including PubMed/MEDLINE, Cochrane Library, and Embase was performed from inception to September 1, 2024 to identify randomized control trials (RCTs) that compared OAC monotherapy with dual antithrombotic therapy in patients with AF and stable CAD. The risk ratios (RRs) were estimated with corresponding 95% confidence intervals (CIs) for all outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of three RCTs reported data for 3945 patients with AF and stable CAD. The mean age of patients was 73.8 (±11.85) years and the mean follow-up was 22 months. OAC monotherapy was associated with a significantly reduced relative risk of major bleeding (RR: 0.55, 95% CI: 0.32–0.95) compared to dual therapy. The risk of all-cause death (RR: 0.85, 95% CI: 0.49–1.48), cardiovascular death (RR: 0.84, 95% CI: 0.50–1.41), any stroke event (RR: 0.74, 95% CI: 0.46–1.18), and myocardial infarction (RR: 1.57, 95% CI: 0.79–3.12) remained comparable across the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Transcatheter and Surgical Mitral Valve Repair in Functional Mitral Regurgitation: Insights From a Real-World Analysis and Future Research Directions","authors":"Ibrahim Manzoor,&nbsp;Mustafa Mansoor","doi":"10.1002/clc.70015","DOIUrl":"10.1002/clc.70015","url":null,"abstract":"&lt;p&gt;Functional mitral regurgitation (FMR) is characterized by normal mitral leaflet morphology but a dilated mitral annulus due to left ventricular dilatation or papillary muscle dysfunction [&lt;span&gt;1&lt;/span&gt;]. The prevalence of FMR is increasing due to predicted demographic changes and it is estimated that by 2030, 4 million people will be diagnosed with FMR in the United States [&lt;span&gt;2&lt;/span&gt;]. Patients with FMR are typically treated with guideline-directed medical therapy (GDMT) but when symptoms occur despite GDMT, surgery or transcatheter intervention is indicated before left ventricular function further deteriorates. Recently, transcatheter edge-to-edge mitral valve repair (TEER) has emerged as a promising treatment modality in this regard. However, there is insufficient data comparing the effectiveness of TEER to the more commonly employed surgical mitral valve repair (SMVr).&lt;/p&gt;&lt;p&gt;To explore this gap, Wang et al. recently presented a real-world analysis comparing the outcomes of TEER and SMVr in patients with FMR by using data from the National Inpatient Sample (NIS) database [&lt;span&gt;3&lt;/span&gt;]. In 6233 and 2524 patients who underwent SMVr and TEER, respectively, the length of hospital stay was considerably shorter for TEER with a mean of 8.59 days for SMVr and 4.13 days for TEER. While the in-hospital mortality rate was similar in both groups, the study showed that SMVr was associated with increased perioperative complications such as cardiogenic shock, cardiac arrest, respiratory failure, fluid and electrolyte disorders, acute kidney injury, cerebrovascular infarction, and bleeding after the procedure. Postprocedural blood transfusion and mechanical ventilation use were also higher in the SMVr group.&lt;/p&gt;&lt;p&gt;This comprehensive study provides valuable data and a nuanced understanding of the comparative outcomes between transcatheter and surgical approaches to mitral valve repair. The meticulous analysis and detailed presentation of results significantly contribute to the field of cardiovascular medicine, offering a robust foundation for future research and clinical practice. For certain patients with anatomical features that make TEER challenging or not feasible, and where surgical risk remains high and prohibitive, transcatheter mitral valve replacement (TMVR) has recently emerged as an attractive option [&lt;span&gt;4&lt;/span&gt;]. While a number of transcatheter replacement devices are under development and clinical investigation, their current use is largely limited to compassionate cases or clinical trials. Consequently, TEER is the first-line transcatheter treatment for both mitral and tricuspid regurgitation in many patients who are not candidates for surgery [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;However, several limitations should be addressed in future research to enhance the robustness of the findings. The study's lack of laboratory or echocardiography data is a notable limitation, and subsequent studies should incorporate these assessments both pre- and pos","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonvitamin K Anticoagulants: Risk of Bleeding When Interacting With Other Medications: A Cohort Study From Medicare","authors":"Ainhoa Gomez-Lumbreras,&nbsp;Madeline Brendle,&nbsp;Krystal Moorman-Bishir,&nbsp;Malinda Tan,&nbsp;Daniel C. Malone","doi":"10.1002/clc.70023","DOIUrl":"10.1002/clc.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients on nonvitamin K antagonist (NVKA) are usually taking other drugs. Potential interaction may increase the gastrointestinal (GI) bleeding risk associated with NVKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Observational cohort study using Medicare data from 2017 to 2020. Participants receiving a NVKA were included. A concomitant overlapping period while on NVKA was assessed for nonsteroidal anti-inflammatory drugs (NSAIDS), selective serotonin reuptake inhibitors (SSRI), antiplatelets, glucocorticoids, aspirin and proton pump inhibitors (PPI). A logistic regression predicting either any bleeding or GI bleeding was conducted estimating the odds ratio (OR) and 95% confidence interval (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 102 531 people on NVKA with mean age 77 years (SD = 9.8) and 55% females (<i>N</i> = 56 671) were included. Previous history of GI bleeding occurred in 2 908 (2.8%) participants, concomitant exposure to PPI occurred in 38 713 (38%), SSRI in 16 487 (16%), clopidogrel in 15 795 (15.4%), NSAIDs in 13 715 (13.4%) and glucocorticoids in 13 715 (13.4%). Risk for any bleeding was shown for clopidogrel (OR: 1.37, 95% CI: 1.30, 1.44), prasugrel/ticagrelor (OR: 1.36, 95% CI: 1.18, 1.58), glucocorticoids (OR: 1.26, 95% CI: 1.19, 1.34), and SSRIs (OR: 1.13, 95% CI: 1.07, 1.19). GI bleeding risk was shown for clopidogrel (OR: 1.44, 95% CI: 1.34, 1.55), prasugrel/ticagrelor (OR: 1.47, 95% CI: 1.20, 1.79), SSRIs (OR: 1.09, 95% CI: 1.01, 1.17) and glucocorticoids (OR: 1.33, 95% CI: 1.23, 1.44). PPI use was correlated with both NSAID (<i>r</i> = 0.07, <i>p</i> ≤ 0.0001) and SSRI use (<i>r</i> = 0.09, <i>p</i> ≤ 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NVKA concomitantly taken with antiplatelets, glucocorticoids, and SSRIs showed an increased risk for any bleeding and GI bleeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Usefulness of Intracoronary Acetylcholine 200 μg Into the Left Coronary Artery as Vasoreactivity Testing: Comparisons With Intracoronary Acetylcholine Maximum 100 μg","authors":"Shozo Sueda,&nbsp;Yutaka Hayashi,&nbsp;Hiroki Ono,&nbsp;Tomoki Sakaue,&nbsp;Shuntaro Ikeda","doi":"10.1002/clc.70001","DOIUrl":"10.1002/clc.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We retrospectively analyzed the usefulness and safety of intracoronary acetylcholine (ACh) 200 μg into the left coronary artery (LCA) as vasoreactivity testing compared with intracoronary ACh 100 μg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited 1433 patients who had angina-like chest pain and intracoronary ACh testing in the LCA, including 1234 patients with a maximum ACh 100 μg and 199 patients with a maximum ACh 200 μg. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis, usual chest pain, and ischemic electrocardiogram (ECG) changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of coronary constriction ≥ 90%, usual chest pain, and ischemic ECG changes with a maximum ACh of 100 μg was markedly higher than that with a maximum ACh of 200 μg. The frequency of unusual chest pain in patients with a maximum ACh of 200 μg was higher than that in those with a maximum ACh of 100 μg (13% vs. 3%, <i>p</i> &lt; 0.001). In patients with rest angina, positive spasm of maximum ACh 100 μg was significantly higher than that of maximum ACh 200 μg, whereas there was no difference regarding positive spasm in patients with atypical chest pain between the two ACh doses. Major complications (1.38% vs. 1.51%, <i>p</i> = 0.8565) and the occurrence of paroxysmal atrial fibrillation (1.81% vs. 2.63%, <i>p</i> = 0.6307) during ACh testing in the LCA were not different between the two maximum ACH doses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intracoronary ACh 200 μg into the LCA is clinically useful and safe for vasoreactivity testing when intracoronary ACh 100 μg dose not provoke spasms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed-Field Ablation in Management of Ventricular Tachycardia: A Systematic Review of Case Reports and Clinical Outcomes","authors":"Amir Askarinejad,&nbsp;Erfan Kohansal,&nbsp;Amirreza Sabahizadeh,&nbsp;Hamed Hesami,&nbsp;Sara Adimi,&nbsp;Majid Haghjoo","doi":"10.1002/clc.70018","DOIUrl":"10.1002/clc.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed-field ablation (PFA) is a cutting-edge technique that employs non-thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo-ablation for treating ventricular tachycardia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed-field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long-term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The absence of complications, high effectiveness, and long-term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}