Clinical Cardiology最新文献

{"title":"LDL-C and hs-CRP Jointly Modify the Effect of Lp(a) on 5-Year Death in Patients With Percutaneous Coronary Intervention","authors":"Jiawen Li,&nbsp;Kailun Yan,&nbsp;Pei Zhu,&nbsp;Xiaofang Tang,&nbsp;Yuejin Yang,&nbsp;Runlin Gao,&nbsp;Jinqing Yuan,&nbsp;Xueyan Zhao","doi":"10.1002/clc.70025","DOIUrl":"10.1002/clc.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent studies have suggested that adverse events associated with lipoprotein(a) [Lp(a)] might be modified by low-density lipoprotein cholesterol (LDL-C) or high-sensitivity C-reactive protein (hs-CRP) levels, but whether LDL-C and hs-CRP jointly mediate the outcome of Lp(a) remains unknown in patients with coronary artery disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A prospective study was conducted, enrolling consecutive 10 724 patients with percutaneous coronary intervention (PCI) in 2013. The endpoint event was all-cause death. A total of 10 000 patients with complete baseline data were finally included. During a median follow-up of 5.1 years, Lp(a) ≥ 30 mg/dL was an independent risk factor of all-cause death in the overall population, LDL-C ≥ 70 mg/dL, and hs-CRP ≥ 2 mg/L population, respectively. According to concurrent LDL-C (70 mg/dL) and hs-CRP (2 mg/L) levels, further analysis revealed that when LDL-C &lt; 70 mg/dL regardless of hs-CRP levels, Lp(a) ≥ 30 mg/dL was not an independent predictor of all-cause death. However, when LDL-C ≥ 70 mg/dL, Lp(a) ≥ 30 mg/dL was independently associated with a higher risk of all-cause death in hs-CRP ≥ 2 mg/L (HR: 1.488, 95% CI: 1.059‒2.092), but not in hs-CRP &lt; 2 mg/L (HR: 1.303, 95% CI: 0.914‒1.856).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among PCI patients, Lp(a)-associated outcome was jointly affected by LDL-C and hs-CRP. As long as LDL-C is well controlled, the adverse effects of increased Lp(a) on cardiovascular risk seem to be weakened, and only when LDL-C and hs-CRP increase at the same time, elevated Lp(a) is associated with poorer long-term outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459376","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":"Risk Factors of Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Grafting Surgery in the Recent 10 Years: Clinical Analysis of 6229 Patients","authors":"Jia-Yi Zhou,&nbsp;Jian-Liang Zhang,&nbsp;Lei Xi,&nbsp;Zhi-Peng Guo,&nbsp;Xiao-Cheng Liu,&nbsp;Zhi-Gang Liu,&nbsp;Qin Yang,&nbsp;Guo-Wei He","doi":"10.1002/clc.24335","DOIUrl":"10.1002/clc.24335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) that prolongs hospitalization and increases expenses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Perioperative risk factors may predict POAF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From March 2015 to January 2023, 6229 patients who underwent isolated CABG and were in sinus rhythm before CABG were included in this retrospective study. The preoperative and postoperative variants of patients were collected and analyzed by univariate analyses between the patients with and without POAF. Multivariate logistic regression analysis was then used to study the independent risk factors for POAF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of POAF in this group of patients was 30.94%. Univariate analyses demonstrated that age (<i>p</i> &lt; 0.001), hypertension (<i>p</i> &lt; 0.001), smoking (<i>p</i> &lt; 0.05), cardiopulmonary bypass (CPB) time (<i>p</i> &lt; 0.01), and ejection fraction (EF, <i>p</i> &lt; 0.01) were the risk factors for POAF. Multivariate logistic regression analysis determined the independent risk factors associated with POAF were old age (odds ratio [OR] = 1.062, <i>p</i> = 0.000) and low EF (OR = 0.980; <i>p</i> = 0.008).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the current era, after isolated CABG surgery, there is still a quite high incidence of POAF (30.94% in this group of CABG patients). The main risk factors correlating to POAF include age, hypertension, smoking, CPB time, and EF. Among these factors, multivariate analysis identified old age and low EF as the independent risk factors associated with POAF. Particular care should be taken in the perioperative period for these patients in the prevention of POAF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459377","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":"Additional Recommendations on Assessment of Left Ventricle End-Diastolic Volume","authors":"Fatma Nur Toksöz,&nbsp;Özden Seçkin Göbüt,&nbsp;Serkan Ünlü","doi":"10.1002/clc.70029","DOIUrl":"10.1002/clc.70029","url":null,"abstract":"<p>We read your article, “Revisiting Echocardiographic Ranges of Left Ventricular End Diastolic Volume Index,” with great interest [<span>1</span>]. As numerous studies demonstrate, the end-diastolic diameter is not an adequate substitute for left ventricular end-diastolic volume (LVEDV) in evaluating dilated left hearts. We agree with your emphasis on LVEDV as a critical diagnostic parameter. However, we offer some observations and suggestions to enhance the discussion further.</p><p>The reclassification of the LVEDV index (LVEDVi), particularly among women, is significant. The fact that nearly 20% of female subjects were reclassified into higher abnormal categories underscores the need for gender-specific cutoffs in future guidelines. The 2015 guidelines disproportionately affect women, making further research into gender-specific physiological differences vital for refining thresholds. Addressing these distinctions would better align future guidelines with the diagnostic needs of female patients.</p><p>We appreciate your acknowledgment of regional variability in left ventricle (LV) parameters, supporting the need for international, multicenter studies. This approach would help establish reference ranges that are more globally representative, especially since your study noted differences in LV size parameters across countries. A global collaborative effort would account for body composition and cardiac anatomy variability worldwide.</p><p>While the 2015 guideline introduced useful refinements, we agree that clinical outcomes should play a greater role in determining classifications. Misclassification could lead to unnecessary diagnostic testing, increasing healthcare costs and patient anxiety. Shifting toward outcome-based classification systems may reduce overdiagnosis and better target interventions for those at real risk.</p><p>Your study demonstrates that significant aortic and mitral regurgitation can impact LVEDVi classification [<span>1</span>]. Further exploration of how controlling for these and other comorbidities could clarify the extent to which LVEDVi changes are due to actual left ventricular enlargement. A more homogeneous study population would enhance the precision of conclusions.</p><p>Lastly, the limitations of using body surface area as an indexing method, particularly for individuals with extreme body compositions, are important [<span>2, 3</span>]. We agree that alternative methods, such as length-based scaling, could offer a more accurate reflection of LV size in obese or extremely thin individuals. Investigating these alternative indexing methods would improve diagnostic accuracy across diverse body types.</p><p>Once again, we commend you on this important contribution to the field and look forward to future research that builds on these findings.</p><p>Sincerely,</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"47 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459373","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":"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":"47 10","pages":""},"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":"47 10","pages":""},"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":"47 10","pages":""},"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":"47 10","pages":""},"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":"47 10","pages":""},"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":"47 10","pages":""},"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":"47 10","pages":""},"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}