Clinical Cardiology最新文献

{"title":"Predictive Ability of the CHA2DS2-VA Score for No-Reflow Phenomenon in ST-Elevation Myocardial Infarction Patients Undergoing Primary PCI","authors":"Ying Sun,&nbsp;Jian Ren,&nbsp;Wei Wang,&nbsp;Chunsong Wang,&nbsp;Min Liu,&nbsp;Jiahui Liu,&nbsp;Xuewen Qi,&nbsp;Hengchen Yao","doi":"10.1002/clc.70439","DOIUrl":"10.1002/clc.70439","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>No-reflow phenomenon (NRP) frequently complicates ST-elevation myocardial infarction (STEMI). This study evaluated the CHA₂DS₂-VA score (CV score) as a predictor of NRP in STEMI patients undergoing primary PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 725 STEMI patients were retrospectively enrolled and stratified by median of CV score (≤ 2 vs. &gt; 2). The predictive ability of the CV score for NRP was assessed using logistic regression, receiver operating characteristic analysis, and DeLong tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NRP incidence was higher in the high CV score group (15.2% vs. 8.7%, <i>p</i> = 0.007). The CV score predicted NRP overall (adjusted OR: 1.295, <i>p</i> = 0.002), but this effect was confined to females (AOR: 1.597, <i>p</i> = 0.002), with no significant association in males. Area under the curve value (AUC) of the CV score for predicting NRP was 0.613 in all patients (38.8% sensitivity and 79.1% specificity, <i>p</i> = 0.001) and 0.673 in females (78.1% sensitivity and 47.6% specificity, <i>p</i> = 0.002). A significant sex × CV score interaction (<i>p</i> = 0.017) confirmed sex-modified predictive value. DeLong tests combining the CV score with laboratory markers improved prediction in males but not females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CV score is a sex-specific predictor of NRP in STEMI, with predictive value in females but not males. These findings support a tailored risk stratification approach: using the CV score alone for female patients, while integrating laboratory and procedural markers for male patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673203","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":"Associations of Healthy Lifestyle With All-Cause and Cardiovascular Disease Mortality in Individuals With Cardiovascular-Kidney-Metabolic Syndrome: Two Prospective Cohort Studies","authors":"Qiqi You,&nbsp;Wan Fu,&nbsp;Mi Xu,&nbsp;Yucen Wu,&nbsp;Aaron Mitchell Lett,&nbsp;Xiaoying Li,&nbsp;Menglin Fan,&nbsp;Shaoyong Xu","doi":"10.1002/clc.70436","DOIUrl":"10.1002/clc.70436","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiovascular-kidney-metabolic (CKM) syndrome poses a major health risk. This study assessed the impact of a healthy lifestyle on all-cause and cardiovascular disease (CVD) mortality in CKM individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 306 831 and 9823 CKM individuals from UK Biobank and NHANES (2007–2018). A healthy lifestyle score was created based on seven factors: no current smoking, moderate drinking, healthy diet, regular physical activity, adequate sleep, low sedentary behavior and appropriate social connection. Primary outcomes were all-cause and CVD mortality from linked health records and death registries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cox regression models showed that higher lifestyle scores were associated with reduced risks of all-cause (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.80–0.82) and CVD mortality (HR: 0.82, 95% CI: 0.80–0.84) in UK Biobank. In NHANES, higher scores were associated with 15% (95% CI: 0.80–0.90) and 11% (95% CI: 0.81–0.99) lower mortality risks. Both regular physical activity (HRs: 0.85 and 0.89 for UK Biobank, 0.76 and 0.73 for NHANES) and low sedentary behavior (HRs: 0.85 and 0.91 for UK Biobank, 0.79 and 0.67 for NHANES) were related to reduced mortality risks (<i>p</i> &lt; 0.05). Participants with non-advanced CKM syndrome and a favorable lifestyle had the lowest mortality risks compared to those with advanced CKM syndrome and an unfavorable lifestyle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A healthy lifestyle, particularly regular physical activity and low sedentary behavior, was significantly associated with lower all-cause and CVD mortality in individuals with CKM syndrome. These associations were stronger in the early stages, highlighting the importance of timely and targeted lifestyle interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673220","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 Disruption of Blood Pressure Circadian Rhythm and Prognosis After Acute Anterior Myocardial Infarction","authors":"Yangge Shao,&nbsp;Yajuan Yang,&nbsp;Chao Wang,&nbsp;Zhiming Yu,&nbsp;Ruxing Wang","doi":"10.1002/clc.70377","DOIUrl":"10.1002/clc.70377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the characteristics of blood pressure (BP) circadian rhythm disruption and its relationship with prognosis in patients with acute anterior ST-elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 330 patients with anterior STEMI who underwent emergency PCI were enrolled in this study (MI group). Additionally, 131 physical examination patients were selected as the control group. Based on 24-h ambulatory blood pressure monitoring (ABPM) results, BP rhythm in both groups was classified into Extreme dipper, Dipper, Non-dipper, and Reverse dipper. The characteristics of BP rhythm were compared between the two groups. Patients with anterior MI were followed up for 1 year postoperatively. The occurrence of major adverse cardiovascular events (MACE) was compared among subgroups with different BP rhythms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of dipper BP in the study group (11.21%) was significantly lower than that of the control group (63.36%) (<i>p</i> = 0.001). The proportions of non-dipper (43.03%) and reverse dipper (40%) BP in the MI group were higher than the control group (22.90% and 7.63%, respectively; all <i>p</i> &lt; 0.001). Multivariate Cox regression analysis, using dipper BP as the reference, showed that reverse dipper BP was independently associated with MACE (HR = 6.417, <i>p</i> = 0.002). The cumulative risk of the primary endpoint event (Log Rank <i>p</i> = 0.021) was significantly higher in the reverse dipper group compared to the dipper group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with anterior STEMI are still under the burden of disrupted BP circadian rhythm and reduced dipper BP rhythm. The reverse dipper BP rhythm may serve as an independent factor of MACE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663477","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 Severe Postoperative Multi-Organ Dysfunction on Long-Term Outcomes After Modified Morrow Surgery","authors":"Tong Wang,&nbsp;La Ta,&nbsp;Kui Zhang,&nbsp;Ran Dong,&nbsp;Yu Xiao,&nbsp;Jiayang Wang","doi":"10.1002/clc.70434","DOIUrl":"10.1002/clc.70434","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The modified Morrow surgery is the gold standard surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). While effective, it carries a risk of postoperative severe multi-organ dysfunction and its impact on long-term cardiovascular outcomes remains poorly understood and controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational cohort study included 380 HOCM patients undergoing the modified Morrow surgery between July 2015 and March 2025. Severe multi-organ dysfunction was defined as a maximum Sequential Organ Failure Assessment (SOFA) score ≥ 11. The primary endpoint was the long-term incidence of major adverse cardiac and cerebrovascular events (MACCEs). Secondary endpoints included heart failure hospitalization (HFH), postoperative atrial fibrillation (AF) ablation, and cardiovascular mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to patients without severe multi-organ dysfunction (SOFA Maximum &lt; 11, <i>n</i> = 234), those with SOFA Maximum ≥ 11 (<i>n</i> = 146) had significantly higher rates of MACCEs (53.4% vs. 17.5%, <i>p</i> &lt; 0.001), cardiovascular mortality (11.6% vs. 0.9%, <i>p</i> &lt; 0.001), HFH (21.9% vs. 8.5%, <i>p</i> &lt; 0.001), and postoperative AF ablation (17.8% vs. 3.8%, <i>p</i> &lt; 0.001). Multivariable Cox proportional hazards regression demonstrated that severe multi-organ dysfunction was independently associated with cardiovascular mortality (HR = 4.157, <i>p</i> = 0.047), MACCEs (HR = 2.296, <i>p</i> &lt; 0.001), HFH (HR = 1.834, <i>p</i> = 0.042), and postoperative AF ablation (HR = 3.987, <i>p</i> &lt; 0.001). Other independent predictors included family history of hypertrophic cardiomyopathy, left ventricular end-systolic dimension, postoperative left ventricular outflow tract velocity, and postoperative surgical intensive care unit ventilation time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Postoperative severe multi-organ dysfunction is independently associated with an increased risk of adverse long-term outcomes after modified Morrow surgery. Incorporating the SOFA score into postoperative risk stratification may help identify high-risk patients warranting intensified long-term management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663428","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":"Correction to \"Trends and Disparities in Acute Myocardial Infarction-Related Mortality With Co-Listed Nicotine Dependence in the United States, 1999-2020\".","authors":"","doi":"10.1002/clc.70432","DOIUrl":"10.1002/clc.70432","url":null,"abstract":"","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":"e70432"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700927","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":"Mortality Related to Different Circulatory Diseases Before, During and After the COVID-19 Pandemic","authors":"Giulia Capodaglio,&nbsp;Ugo Fedeli,&nbsp;Susanna Levantesi,&nbsp;Paolo Girardi","doi":"10.1002/clc.70433","DOIUrl":"https://doi.org/10.1002/clc.70433","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic caused a global rise in cardiovascular mortality. In Italy, a large excess deaths from ischemic heart disease (IHD), cerebrovascular disease (CVD), hypertensive diseases (HD), and atrial fibrillation (AF) was observed early during the pandemic. Whether mortality has since returned to pre-pandemic levels remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzed mortality data for residents aged ≥ 40 in the Veneto Region, Italy, using multiple causes of death (MCOD) from death certificates. Age-standardized monthly mortality rates were computed for IHD, CVD, HD, and AF. Forecasts for 2023 were generated using two scenarios: excluding the pandemic period (2008–2019) and including it (2008–2022). Seasonal ARIMA and Lee-Carter models were applied, and observed 2023 rates were compared with forecasts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2020, all circulatory disease categories showed a mortality peak, especially HD (+29%). Although rates decreased in 2021–2022, they remained significantly above pre-pandemic levels. In 2023, observed rates for all conditions were close to those forecasted using the 2008–2019 baseline. By contrast, observed rates were significantly lower than expected when using the 2008–2022 baseline. Seasonal peaks were still observed in December 2023, associated with the circulation of multiple respiratory viruses. Lee-Carter model results confirmed a general re-alignment of 2023 mortality with pre-pandemic patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By 2023, mortality from major circulatory diseases in the Veneto Region largely returned to pre-pandemic trends, suggesting limited long-term excess mortality. The findings underscore the value of MCOD data and time-series modeling in capturing both short-term disruptions and long-term recovery patterns in population health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617300","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 “Survival Improvement With Steroid Use for Pulmonary Veno-Occlusive Disease With the Aid of Pulmonary Vasodilators and Tyrosine-Kinase Inhibitor, a Retrospective Study”","authors":"Wajeeha Khan,&nbsp;Muhammad Faizan Khan,&nbsp;Rafsha Khan","doi":"10.1002/clc.70430","DOIUrl":"https://doi.org/10.1002/clc.70430","url":null,"abstract":"&lt;p&gt;We read with great interest the article by Finger et al. [&lt;span&gt;1&lt;/span&gt;], which concluded that prednisolone use was associated with improved survival in patients with pulmonary veno-occlusive disease (PVOD). This work is particularly relevant given the absence of proven medical treatments for PVOD and its poor clinical prognosis. While we commend the authors for investigating a potential therapy in this challenging disease, several methodological limitations significantly weaken the strength of their conclusions and should be carefully considered when interpreting the results.&lt;/p&gt;&lt;p&gt;Our primary concern relates to the statistical fragility of the study's principal finding. It rests on a log-rank &lt;i&gt;p&lt;/i&gt; = 0.01 derived from only five patients per group, making this result highly fragile. Notably, three patients in the steroid group remained alive at the study cutoff; consequently, the reported statistical significance depends on the outcomes of only a few individuals and may therefore be highly unstable. If even one of these patients had died earlier, the difference may no longer have reached statistical significance [&lt;span&gt;2&lt;/span&gt;]. Notably, the authors' own data acknowledge this fragility implicitly, as three of the five steroid-treated patients had not reached the outcome event at the time of analysis, leaving the result dependent on follow-up duration as much as treatment effect. Evidence based on such a limited number of events provides a weak basis for inference, as small changes can substantially alter the results. In this context, the &lt;i&gt;p&lt;/i&gt; value is more likely to reflect the constraints of a very small sample than true efficacy.&lt;/p&gt;&lt;p&gt;Two additional concerns further weaken the study's conclusions. First, epoprostenol exposure was starkly unequal between groups, used in four of five non-steroid patients but none of the steroid-treated patients, an imbalance the original authors themselves acknowledge as a possible contributor to the non-steroid group's worse prognosis [&lt;span&gt;3&lt;/span&gt;]. Epoprostenol is not a neutral drug and carries a well-recognized risk of pulmonary edema in PVOD patients. Consequently, differential epoprostenol-related harm in the non-steroid group may have independently worsened their outcomes, creating a false appearance of prednisolone efficacy rather than reflecting any true therapeutic benefit.&lt;/p&gt;&lt;p&gt;Second, the groups were treated during different time periods (2002–2006 vs. 2006–2018), separated by more than a decade of clinical progress. Over this period, advances in clinical practice and supportive care are likely to have influenced patient outcomes [&lt;span&gt;4&lt;/span&gt;]. This period coincided with the introduction of EIF2AK4 mutation screening and expanded transplant referral pathways, both of which may independently improve survival in PVOD patients. While the authors argue that no major treatment advance occurred during this interval and that background characteristics were otherwise similar between groups","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617364","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 “Association of Ticagrelor Metabolic SNPs With Adverse Drug Reactions in Patients With Acute Coronary Syndrome”","authors":"Yanyan Bai,&nbsp;Cheng Liu,&nbsp;Liuliu Feng","doi":"10.1002/clc.70428","DOIUrl":"10.1002/clc.70428","url":null,"abstract":"&lt;p&gt;We read with great interest the recent study by Zhang et al. on the association between CYP3A4/5 genetic polymorphisms and adverse drug reactions to ticagrelor [&lt;span&gt;1&lt;/span&gt;]. This prospective study established a strong link between the CYP3A5 rs776746 CC genotype and ticagrelor-related dyspnea, offering a potential genetic tool for precision medicine. However, we believe several aspects warrant further discussion.&lt;/p&gt;&lt;p&gt;First, the statistical analysis in this study did not correct for multiple hypothesis testing. The simultaneous examination of associations between two single-nucleotide polymorphisms (rs776746, rs2242480) and multiple clinical endpoints (dyspnea, bleeding, revascularization, mortality) significantly increases the risk of obtaining false-positive results (Type I error) by chance. In genetic association studies, correction for multiple testing is a standard procedure to ensure the robustness of conclusions [&lt;span&gt;2&lt;/span&gt;]. Some of the reported &lt;i&gt;p&lt;/i&gt; values in the article are borderline significant and may lose statistical significance if relatively conservative methods such as Bonferroni correction or false discovery rate (FDR) control are applied. Therefore, in the absence of validation in an independent cohort, interpretation of the current findings should be approached with caution.&lt;/p&gt;&lt;p&gt;Second, the definition of the primary endpoint, dyspnea, in the study is overly broad, potentially masking important clinical heterogeneity. The study defined an endpoint event as Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 1, employing a binary classification that fails to distinguish events of differing clinical significance. Evidence from large-scale clinical trials indicates that ticagrelor-associated dyspnea is typically mild, transient, and in most cases does not affect long-term prognosis or treatment adherence [&lt;span&gt;3&lt;/span&gt;]. The events of critical clinical importance are moderate-to-severe dyspnea (grade 2 and above) that lead to reduced patient adherence or unplanned treatment discontinuation. Aggregating all grades of dyspnea for statistical analysis may dilute the predictive specificity of this genotype for the severe adverse reactions that are of genuine clinical concern. Future research should employ more granular endpoint stratification and integrate patient-reported outcomes such as the proportion of dyspnea leading to treatment discontinuation and symptom duration, to enhance the clinical applicability of predictive models.&lt;/p&gt;&lt;p&gt;Finally, the study failed to evaluate the impact of genotypes on net clinical benefit, which may result in an imbalanced risk assessment. The core endpoints of the study focused solely on adverse drug reactions (dyspnea and bleeding), overlooking the influence of genotypes on drug efficacy—specifically, the prevention of ischemic events such as stent thrombosis or recurrent myocardial infarction. Clinical decision-making is essentially a dynamic balance between ischemic a","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599825","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":"Dynamic Co-Evolution of Obesity-Metabolic-Inflammatory for Cardiovascular Disease Risk Stratification in Middle-Aged and Older Adults: A Data-Driven Joint Trajectory Analysis","authors":"Qinggao Wang,&nbsp;Yilu Lei,&nbsp;Qingfeng Zhou,&nbsp;Yan Long,&nbsp;Yinjuan Lai","doi":"10.1002/clc.70429","DOIUrl":"10.1002/clc.70429","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiovascular disease (CVD) risk assessment based on single-time-point measurements may inadequately capture the dynamic interplay of obesity, metabolic dysfunction, and chronic inflammation. Understanding their long-term co-evolution may improve CVD risk stratification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study. Participants aged ≥ 45 years with repeated measurements of body mass index (BMI), triglyceride-glucose (TyG) index, and high-sensitivity C-reactive protein (hsCRP) between 2011 and 2015 were included. Joint trajectories of these obesity-metabolic-inflammatory markers were identified using the KmL3D clustering algorithm. Incident CVD (heart disease or stroke) was ascertained during follow-up from 2015 to 2020. Cox proportional hazards models were applied to evaluate associations between trajectory groups and CVD risk after adjustment for demographic, lifestyle, and clinical covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4483 participants (mean age 57.8 years; 52.6% women), four distinct joint trajectory patterns were identified: a sustained low-risk profile (46.8%), an obesity-predominant profile (26.7%), a metabolic–obesity-driven profile (17.1%), and an inflammation-dominant profile (9.4%). During a median follow-up of 5.0 years, 592 incident CVD events occurred. Compared with the low-risk profile, all adverse trajectory groups were associated with significantly higher CVD risk, with hazard ratios ranging from 1.35 to 1.46 after full adjustment. Associations were more pronounced for stroke, particularly among individuals with a metabolic–obesity-driven trajectory. Findings were robust across sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Distinct dynamic co-evolution patterns of obesity, metabolic dysfunction, and inflammation identify population subgroups with substantially different risks of incident CVD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599895","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 Predictive Value of Platelet-to-Lymphocyte Ratio Before and After Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction: A Retrospective Cohort Study in Palestine","authors":"Anwar Zahran,&nbsp;Saja Amer,&nbsp;Mohammad Bdair,&nbsp;Seema Hameedi,&nbsp;Roa Badran,&nbsp;Mays Safa,&nbsp;Abdelfattah M. Dahmas,&nbsp;Ahmad Mohammad,&nbsp;Abdul-rahman Abdel-karim,&nbsp;Zaher Nazzal","doi":"10.1002/clc.70422","DOIUrl":"10.1002/clc.70422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inflammation and thrombosis influence short-term outcomes after primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). The platelet-to-lymphocyte ratio (PLR) is an inexpensive marker that may support bedside risk stratification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether pre-PCI and post-PCI PLR predict in-hospital outcomes and 90-day all-cause mortality in STEMI patients undergoing primary PCI in Palestine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included STEMI patients referred for primary PCI at An-Najah National University Hospital. Of 413 eligible patients, 118 were excluded for incomplete records, leaving 295 patients for analysis. PLR was measured before and after PCI and dichotomized using ROC-derived cutoffs: pre-PCI PLR &lt; 21.68 versus ≥ 21.68 and post-PCI PLR &lt; 14.85 versus ≥ 14.85. Outcomes were compared between groups, and multivariable logistic regression was used to assess independent associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Elevated pre-PCI PLR was associated with greater in-hospital clinical instability and remained independently associated with the composite in-hospital clinical endpoint, both per 10-unit increase (OR 1.41, 95% CI 1.13–1.74; <i>p</i> = 0.002) and using the cutoff ≥ 21.68 (OR 2.90, 95% CI 1.55–5.44; <i>p</i> &lt; 0.001). However, pre-PCI PLR was not independently associated with heart failure or 90-day mortality. Post-PCI PLR showed stronger prognostic value and was independently associated with composite in-hospital events, heart failure, and 90-day mortality, both as a continuous variable and using the cutoff ≥ 14.85.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Post-PCI PLR demonstrated stronger prognostic value than pre-PCI PLR and may serve as a simple, low-cost adjunctive marker for short-term risk stratification after primary PCI in STEMI patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590613","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}