Clinical Cardiology最新文献

{"title":"What US Cardiology Can Learn From the 2023 ESC Guidelines for the Management of Acute Coronary Syndromes","authors":"Nanette K. Wenger","doi":"10.1002/clc.24329","DOIUrl":"10.1002/clc.24329","url":null,"abstract":"<p>Recognizing that acute coronary syndromes (ACSs) constitute a spectrum encompassing unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI), the 2023 European Society of Cardiology Guidelines [<span>1</span>] for the management of ACSs addressed all three. This differs from the prior US guidelines that individually addressed unstable angina, NSTEMI, and STEMI. The 2023 ESCACS Guidelines thus encompass comprehensive patient management from admission to long-term care, again including what in prior US guidelines would have been a secondary prevention guideline. In addition, the task force included a patient member who provided a patient perspective that is highlighted in the European publication.</p><p>Because 80% of both women and men with ACS present with chest pain or pressure, this symptom is detailed in the guidelines, derived in part from the US Chest Pain guideline [<span>2</span>]. The ESC document noted that additional symptoms such as diaphoresis, indigestion or epigastric pain, and shoulder or arm pain occur commonly in both women and men with an ACS. However, some symptoms appear to be more common in women, including dizziness and syncope, nausea and vomiting, jaw and back pain, shortness of breath, pain between the shoulder blades, palpitations, and fatigue.</p><p>In advancing the science and implementation, the 2023 Guidelines offer a conceptual approach of five items: think A.C.S. at the initial assessment, think invasive management, think antithrombotic therapy, think revascularization, and think secondary prevention. To further explain the thinking A.C.S. at the initial evaluation of patients with suspected ACS, “A” relates to an abnormal ECG (performing an ECG urgently to assess for evidence of ischemia or other abnormalities), “C” considers the clinical context and other available investigations, and “S” for stable, performing an examination to assess whether the patient is clinically and vitally stable.</p><p>The guidelines (Figure 1) graphically explore the spectrum of clinical presentations such that the patient may initially have had chest pain, but at presentation either has minimal or no symptoms; to the patient with increasing chest pain or other symptoms; to the patient with persistent chest pain or symptoms; to the patient with cardiogenic shock or acute heart failure; and finally, the patient who presents with a cardiac arrest. The ECG may be normal at presentation, may have ST segment depression as potentially an NSTEMI, or may have ST segment elevation leading to the immediate diagnosis of STEMI. If the high-sensitivity troponin [<span>3</span>] is not elevated, the resultant diagnosis is unstable angina, but the characteristic rise and fall of high-sensitivity troponin does not differentiate between NSTEMI and STEMI.</p><p>As noted, the initial ACS assessment includes the electrocardiogram, physical examination, clinical history, vital signs, and high-sensit","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916224","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 Effectiveness of High-Intensity Statins Versus Low/Moderate-Intensity Statins Plus Ezetimibe in Patients With Atherosclerotic Cardiovascular Disease for Reaching LDL-C Goals: A Systematic Review and Meta-Analysis","authors":"Hamidreza Soleimani,&nbsp;Asma Mousavi,&nbsp;Shayan Shojaei,&nbsp;Kiarash Tavakoli,&nbsp;Dorsa Salabat,&nbsp;Farid Farahani Rad,&nbsp;Mani K. Askari,&nbsp;John Nelson,&nbsp;Mohammad Ruzieh,&nbsp;Kaveh Hosseini","doi":"10.1002/clc.24334","DOIUrl":"10.1002/clc.24334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It remains controversial whether adding ezetimibe to low/moderate-intensity statins has a more beneficial impact on the treatment efficacy and safety of patients with existing atherosclerotic cardiovascular disease (ASCVD) compared to high-intensity statin regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>A combination of low/moderate-intensity statins plus ezetimibe might be more effective and safer than high-intensity statin monotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched databases for randomized controlled trials comparing lipid profile alterations, drug-related adverse events, and MACE components between high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. Pooled risk ratios (RR), mean differences (MD), and 95% confidence intervals (95% CI) were estimated using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our comprehensive search resulted in 32 studies comprising 6162 patients treated with monotherapy against 5880 patients on combination therapy. Combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels compared to monotherapy (MD = −6.6, 95% CI: −10.6 to −2.5); however, no significant differences were observed in other lipid parameters. Furthermore, the combination therapy group experienced a lower risk of myalgia (RR = 0.27, 95% CI: 0.13–0.57) and discontinuation due to adverse events (RR = 0.61, 95% CI: 0.51–0.74). The occurrence of MACE was similar between the two treatment groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding ezetimibe to low/moderate-intensity statins resulted in a greater reduction in LDL-C levels, a lower rate of myalgia, and less drug discontinuation compared to high-intensity statin monotherapy in patients with existing cardiovascular disease. However, according to our meta-analysis, the observed reduction in LDL-C levels in the combination group did not correlate with a reduction in MACE compared to the high-intensity statin group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970742","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":"Machine Learning Constructed Based on Patient Plaque and Clinical Features for Predicting Stent Malapposition: A Retrospective Study","authors":"Qianhang Xia,&nbsp;Chancui Deng,&nbsp;Shuangya Yang,&nbsp;Ning Gu,&nbsp;Youcheng Shen,&nbsp;Bei Shi,&nbsp;Ranzun Zhao","doi":"10.1002/clc.24332","DOIUrl":"10.1002/clc.24332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stent malapposition (SM) following percutaneous coronary intervention (PCI) for myocardial infarction continues to present significant clinical challenges. In recent years, machine learning (ML) models have demonstrated potential in disease risk stratification and predictive modeling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>ML models based on optical coherence tomography (OCT) imaging, laboratory tests, and clinical characteristics can predict the occurrence of SM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 337 patients from the Affiliated Hospital of Zunyi Medical University, China, who had PCI and coronary OCT from May to October 2023. We employed nested cross-validation to partition patients into training and test sets. We developed five ML models: XGBoost, LR, RF, SVM, and NB based on calcification features. Performance was assessed using ROC curves. Lasso regression selected features from 46 clinical and 21 OCT imaging features, which were optimized with the five ML algorithms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the prediction model based on calcification features, the XGBoost model and SVM model exhibited higher AUC values. Lasso regression identified five key features from clinical and imaging data. After incorporating selected features into the model for optimization, the AUC values of all algorithmic models showed significant improvements. The XGBoost model demonstrated the highest calibration accuracy. SHAP values revealed that the top five ranked features influencing the XGBoost model were calcification length, age, coronary dissection, lipid angle, and troponin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ML models developed using plaque imaging features and clinical characteristics can predict the occurrence of SM. ML models based on clinical and imaging features exhibited better performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11310765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906027","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 Phenotypic Age and the Risk of Mortality in Patients With Heart Failure: A Retrospective Cohort Study","authors":"Xuhong Xu,&nbsp;Zhiqi Xu","doi":"10.1002/clc.24321","DOIUrl":"10.1002/clc.24321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronological age (CA) is an imperfect proxy for the true biological aging state of the body. As novel measures of biological aging, Phenotypic age (PhenoAge) and Phenotypic age acceleration (PhenoAgeAccel), have been shown to identify morbidity and mortality risks in the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>PhenoAge and PhenoAgeAccel might be associated with mortality in heart failure (HF) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cohort study extracted adult data from the National Health and Nutrition Examination Survey (NHANES) databases. Weighted univariable and multivariable Cox models were performed to analyze the effect of PhenoAge and PhenoAgeAccel on all-cause mortality in HF patients, and hazard ratio (HR) with 95% confidence intervals (CI) was calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 845 HF patients were identified, with 626 all-cause mortality patients. The findings suggested that (1) each 1- and 10-year increase in PhenoAge were associated with a 3% (HR = 1.03, 95% CI: 1.03–1.04) and 41% (HR = 1.41, 95% CI: 1.29–1.54) increased risk of all-cause mortality, respectively; (2) when the PhenoAgeAccel &lt; 0 as reference, the ≥ 0 group was associated with higher risk of all-cause mortality (HR = 1.91, 95% CI = 1.49–2.45). Subgroup analyses showed that (1) older PhenoAge was associated with an increased risk of all-cause mortality in all subgroups; (2) when the PhenoAgeAccel &lt; 0 as a reference, PhenoAgeAccel ≥ 0 was associated with a higher risk of all-cause mortality in all subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older PhenoAge was associated with an increased risk of all-cause mortality in HF patients. PhenoAge and PhenoAgeAccel can be used as convenient tools to facilitate the identification of at-risk individuals with HF and the evaluation of intervention efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901111","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":"Comparison of the Application Value of Transthoracic Echocardiography in Diagnosing Patent Foramen Ovale Under Different States of Stimulation: A Retrospective Study","authors":"Jianwei Shi,&nbsp;Haijuan Gu,&nbsp;Wenjun Fan,&nbsp;Jiesheng Xia,&nbsp;Huanhuan Gu","doi":"10.1002/clc.24319","DOIUrl":"10.1002/clc.24319","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to evaluate the application value of contrast-enhanced transthoracic echocardiography (cTEE) in the diagnosis of patent foramen ovale (PFO) under different states of stimulation, with the goal of enhancing the accuracy and efficiency of PFO diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This research consecutively enrolled patients suspected of having PFO from October 2022 to February 2024, presenting primary clinical symptoms such as unexplained syncope, headache, dizziness, and stroke. Patients underwent standard transthoracic echocardiography (TTE) and cTEE under three different states of stimulation (resting state, coughing, and Valsalva maneuver). Based on the presence of microbubbles in the left heart and their initial appearance time, patients were classified into PFO and control groups, with further diagnostic confirmation via transesophageal echocardiography (TEE) or foramen ovale closure procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study results revealed significant differences between the PFO and control groups regarding age (<i>p</i> = 0.034) and headache symptoms (<i>p</i> = 0.001). In the PFO group, TTE showed a higher positivity rate both at rest and during coughing, highlighting the association between PFO and specific clinical symptoms. The number of microbubbles observed during TTE increased significantly under various stimulation states, particularly during the Valsalva maneuver (<i>p</i> &lt; 0.05). This increase became more pronounced as the duration of the maneuver was extended, underscoring the differential response of PFO patients under varied physiological testing conditions, especially during prolonged Valsalva maneuvers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study confirms the significant value of cTEE in diagnosing PFO under different stimulation states, particularly emphasizing the application of the Valsalva maneuver to significantly improve the sensitivity and specificity of PFO detection. Thus, incorporating cTEE examinations under various stimulation states holds significant clinical importance for enhancing the accuracy and efficiency of PFO diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896866","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":"Comment on “The Relationship Between Ambulatory Arterial Stiffness Index and Incident Atrial Fibrillation”","authors":"Mustafa Candemir,&nbsp;Emrullah Kızıltunç","doi":"10.1002/clc.24333","DOIUrl":"10.1002/clc.24333","url":null,"abstract":"<p>We read with great interest this observational cohort study with a median duration of 4 years by Boos et al. [<span>1</span>]. In this study, ambulatory arterial stiffness index (AASI) was found to be an independent predictor of the development of AF [<span>1</span>]. First of all, we would like to congratulate the authors of this article for raising awareness that parameters (such as AASI) obtained from ambulatory blood pressure monitoring (ABPM) have independent predictive value in many important diseases [<span>2, 3</span>]. We thought some points should be clarified so we decided to add some helpful comments on this article.</p><p>It is known that the diagnosis duration of patients with diseases like hypertension, heart failure, and diabetes may affect AASI, which provides information about arterial stiffness [<span>3, 4</span>]. Therefore, was there a statistically significant difference between the diagnosis duration of these diseases (hypertension, heart failure, and diabetes) in the AF and non-AF groups?</p><p>In addition, the incidence of heart failure and ischemic stroke was higher in the AF group in the study. We know that these diseases have an impact on AASI [<span>2</span>]. Therefore, we think that it would be appropriate to include these diseases as confounding variables in the Cox regression analysis. The authors said that they limited the number of variables included in the regression model because the AF incidence was 9.1% (<i>n</i> = 75). However, in regression analysis, the number of events per variable can be between 5–9. It is known that the results of this analysis are correct [<span>5</span>]. Therefore, the number of variables evaluated in the regression analysis could have been increased to eight. Finally, the difference in β-blocker use rates between groups may have caused AASI to lead to a statistically significant difference between the groups. Purifying the study results from the effects of the drugs used would also enable better interpretation of the results.</p><p>Despite these comments, we agree that this study will contribute greatly to the literature.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893000","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 Efficiency of Cephalic Vein Puncture by Modified Seldinger Technique Compared to Subclavian Vein Puncture for Cardiac Implantable Electronic Devices","authors":"Marie-Christine Weidauer,&nbsp;Enzo Knüpfer,&nbsp;Jörg Lottermoser,&nbsp;Usama Alkomi,&nbsp;Steffen Schoen,&nbsp;Carsten Wunderlich,&nbsp;Marian Christoph,&nbsp;Alexander Francke","doi":"10.1002/clc.24327","DOIUrl":"10.1002/clc.24327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single-center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 229 consecutive patients receiving a CIED were included in the registry. Sixty-one patients were implanted by primary or bail-out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Implantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791991","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":"Impact of the COVID-19 Pandemic on Conduct and Results of CLEAR Outcomes Trial","authors":"Abhayjit Singh,&nbsp;Luke J. Laffin,&nbsp;Ashish Sarraju,&nbsp;A. Michael Lincoff,&nbsp;Stephen J. Nicholls,&nbsp;LeAnne Bloedon,&nbsp;William J. Sasiela,&nbsp;Na Li,&nbsp;Paula Robinson,&nbsp;Stephanie Kelly,&nbsp;Denise Mason,&nbsp;Steven E. Nissen","doi":"10.1002/clc.24328","DOIUrl":"10.1002/clc.24328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The COVID-19 pandemic disrupted clinical research. CLEAR Outcomes investigated the effect of bempedoic acid (BA) versus placebo in 13 970 patients with statin intolerance and high cardiovascular (CV) risk. BA reduced the risk of the primary endpoint (composite of CV death, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization) by 13%. CLEAR Outcomes began before and continued for 2.7 years after the start of the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The impact of the COVID-19 pandemic on patient disposition, adverse events, and major adverse CV events (MACE) in CLEAR Outcomes was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rates of severe infection, hospitalization, or first MACE associated with a positive COVID-19 test were low and balanced between treatment groups. Rates of all-cause death, non-CV death, and undetermined death increased in the pandemic period compared with the pre-pandemic period, while rates of CV death with a known etiology remained stable. A sensitivity analysis excluding undetermined deaths occurring after the onset of the pandemic from the CV death designation yielded hazard ratios of 0.84 (95% CI, 0.76–0.93) for the primary endpoint and 0.94 (95% CI, 0.76–1.16) for the secondary endpoint of CV death, compared with 0.87 (95% CI, 0.79–0.96) and 1.04 (95% CI, 0.88–1.24), respectively, in the original analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CLEAR Outcomes trial continued uninterrupted throughout the COVID-19 pandemic. Certain trial endpoints may have been impacted by the pandemic. Specifically, the classification of undetermined deaths as CV deaths may have attenuated the effect of BA on key efficacy endpoints.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791990","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":"Comparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis","authors":"Parisa Fallahtafti,&nbsp;Hamidreza Soleimani,&nbsp;Pouya Ebrahimi,&nbsp;Amirhossein Ghaseminejad-Raeini,&nbsp;Elaheh Karimi,&nbsp;Amirhossein Shirinezhad,&nbsp;Mahshad Sabri,&nbsp;Mehdi Mehrani,&nbsp;Homa Taheri,&nbsp;Robert Siegel,&nbsp;Neeraj Shah,&nbsp;Michael Nanna,&nbsp;Diaa Hakim,&nbsp;Kaveh Hosseini","doi":"10.1002/clc.24324","DOIUrl":"10.1002/clc.24324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis (AS). Since coronary artery disease (CAD) is common among these patients, it is crucial to choose the best method and timing of revascularization. This study aims to compare different timing strategies of percutaneous coronary intervention (PCI) in patients with severe AS undergoing TAVI to clarify whether PCI timing affects the patients' outcomes or not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A frequentist network meta-analysis was conducted comparing three different revascularization strategies in patients with CAD undergoing TAVI. The 30-day all-cause mortality, in-hospital mortality, all-cause mortality at 1 year, 30-day rates of myocardial infarction (MI), stroke, and major bleeding, and the need for pacemaker implantation at 6 months were analyzed in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our meta-analysis revealed that PCI during TAVI had higher 30-day mortality (RR = 2.46, 95% CI = 1.40–4.32) and in-hospital mortality (RR = 1.70, 95% CI = [1.08–2.69]) compared to no PCI. Post-TAVI PCI was associated with higher 1-year mortality compared to other strategies. While no significant differences in major bleeding or stroke were observed, PCI during TAVI versus no PCI (RR = 3.63, 95% CI = 1.27–10.43) showed a higher rate of 30-day MI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest that among patients with severe AS and CAD undergoing TAVI, PCI concomitantly with TAVI seems to be associated with worse 30-day outcomes compared with no PCI. PCI after TAVI demonstrated an increased risk of 1-year mortality compared to alternative strategies. Choosing a timing strategy should be individualized based on patient characteristics and procedural considerations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757443","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 Handgrip Strength and Mortality of Patients With Coronary Artery Disease: A Meta-Analysis","authors":"Meiling Xiao,&nbsp;Yu Lu,&nbsp;Hongqiu Li,&nbsp;Zhonghai Zhao","doi":"10.1002/clc.24322","DOIUrl":"10.1002/clc.24322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Muscular strength has been linked to increased risk of cardiovascular disease in the community population. The aim of this systematic review and meta-analysis is to evaluate the association between weak handgrip strength (HGS) and mortality risk in patients with coronary artery disease (CAD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To carry out the meta-analysis, an extensive search was conducted on databases such as PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI to identify observational studies with longitudinal follow-up. Random-effects models were used to combine the findings, taking into account the potential influence of heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight observational studies involving 10 543 patients with CAD were included. During a mean follow-up duration of 20.4 months, 1327 (12.6%) patients died. Pooled results showed that weak HGS at baseline was associated with an increased risk of all-cause mortality during follow-up (risk ratio [RR]: 1.95, 95% confidence interval: 1.50 to 2.55, <i>p</i> &lt; 0.001; <i>I</i>² = 62%). Subgroup analysis suggested a stronger association between weak HGS and increased mortality in older patients with CAD as compared to that of overall adult patients with CAD (RR: 3.01 vs. 1.60, <i>p</i> for subgroup difference = 0.004). Subgroup analyses according to study location, design, subtype of CAD, follow-up duration, analytical model, and study quality scores showed similar results (<i>p</i> for subgroup difference all &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Weak HGS at baseline is associated with an increased risk of mortality in patients with CAD, particularly in older patients with CAD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757442","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}