Clinical Cardiology最新文献

{"title":"National Trends & Disparities in Ischemic Heart Disease & Cardiac Arrhythmias Related Mortality in the United States From 1999 to 2024: A CDC Wonder Analysis","authors":"Muhammad Murtaza,&nbsp;Muhammad Mujtaba Rasool,&nbsp;Sheikh Muhammad Ebtehaj Ali,&nbsp;Muhammad Farhan,&nbsp;Laiba Ilyas,&nbsp;Ahmed Asad Raza,&nbsp;Hammad Amjad,&nbsp;Sumet Kumar,&nbsp;Zoha Khan,&nbsp;Sadia Tahir,&nbsp;Abedin Samadi","doi":"10.1002/clc.70427","DOIUrl":"10.1002/clc.70427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ischemic heart disease and cardiac arrhythmias are major contributors to cardiovascular mortality in the United States. Understanding long-term national trends and demographic disparities is essential for guiding prevention strategies and public health policies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cross-sectional analysis was conducted using mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2024. Deaths in which IHD and a cardiac arrhythmia were both recorded were identified using ICD-10 codes. Crude mortality rates and age-adjusted mortality rates per 100,000 population were calculated. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Mortality patterns were further stratified by sex, race/ethnicity, age group, geographic region, and urbanization status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1 885 917 deaths were attributed to IHD and cardiac arrhythmias between 1999 and 2024. The overall AAMR declined from 41.97 in 1999 to 31.75 in 2024. Mortality decreased substantially from 1999 to 2009, stabilized through 2018, and increased sharply during 2018–2021 before declining again through 2024. The cumulative AAMR was 45.09 among males and 23.33 among females. Mortality varied across racial and ethnic groups, geographic regions, urbanization levels, and age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although overall mortality related to IHD and cardiac arrhythmias has declined over the past two decades, demographic and geographic differences persist. The temporary rise during 2018–2021 coincided with the COVID-19 pandemic period and underscores the need for sustained prevention strategies and equitable healthcare access.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599823","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 Trend in Patients With Heart Failure and Psychoactive Substance Abuse in the United States—Pre- and Post-COVID-19 Pandemic Perspective (1999−2023)","authors":"Emad Uddin Sajid,&nbsp;Ayesha Irfan,&nbsp;Muhammad Kashan,&nbsp;Syed Rayyan Ahmed,&nbsp;Muhammad Hasnain Azeem,&nbsp;Tooba Ali,&nbsp;Mabel Waqar,&nbsp;Muneeba Khan,&nbsp;Erum Shahzadi Malik,&nbsp;Md Ariful Haque","doi":"10.1002/clc.70425","DOIUrl":"10.1002/clc.70425","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study evaluates national trends in heart failure (HF) and psychoactive substance abuse-related mortality among adults aged 25 years and older in the United States (US) from 1999 to 2023, stratified by sex, age, race/ethnicity, geographic regions, and the COVID-19 pandemic period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 1999 to 2023 were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMR) and annual percentage changes (APC) were calculated using Joinpoint regression. ICD-10 codes I50, I50.1, I50.9 (Heart Failure), and F10-19 (Psychoactive Substance Use) were used to identify the conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 771 739 deaths were recorded from 1999 to 2023 among individuals aged 25 and older. Most deaths occurred in medical facilities (39.24%), followed by decedents' homes (34.14%), long-term care facilities (16.30%), hospice (6.65%), and other settings (3.67%). The AAMR increased markedly from 1.68 in 1999 to 20.7 in 2023 (AAPC of 12.09, 95% confidence interval [CI]: 10.97−14.26). A substantial increase was observed from 1999 to 2005 (APC: 38.5%, 95% CI: 29.1–55.8), followed by a slower increase until 2020 (APC: 5.68%, 95% CI: 5.02–14.8). Men showed consistently higher AAMRs than females (18.8 vs. 8.65). By age group, mortality was highest among individuals aged 65 years and older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Using CDC WONDER data (1999–2023), we found a sharp rise in HF mortality linked to psychoactive substance abuse, from 1.68 to 20.7 per 100 000. Mortality burden was highest among males, older adults, non-Hispanic White individuals, and rural populations, highlighting widening demographic and geographic disparities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599884","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":"Letter to the Editor: Methodological Concerns Regarding “BCR in Heart Failure: When the Abstract Outruns the Evidence”","authors":"Jobab Nadeem,&nbsp;Hafisba Afzal,&nbsp;Own Muhammad,&nbsp;Aima Rizwan","doi":"10.1002/clc.70431","DOIUrl":"10.1002/clc.70431","url":null,"abstract":"&lt;p&gt;Re: Cabanillas-Lazo et al., systematic review of BCR in heart failure [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Cabanillas-Lazo et al. deserve credit for tackling the prognostic value of the blood urea nitrogen-to-creatinine ratio (BCR) in heart failure. Twenty cohort studies, over 21 000 patients, a registered protocol, dual quality appraisal. This is a serious effort on a marker that's cheap, accessible, and biologically plausible. Still, we think the abstract drifts from what the full text actually supports, in four ways.&lt;/p&gt;&lt;p&gt;The analytical plan changed, and nobody mentions it. The review was PROSPERO-registered as a meta-analysis but ended up as a narrative synthesis because of heterogeneity. Fair enough, that happens. But the abstract doesn't say so, and every effect estimate it reports therefore comes from a single study, not a pooled one. That matters, especially since Zhou et al.'s overlapping 14-study meta-analysis managed a pooled mortality estimate (HR 1.67, 95% CI 1.38–2.00) [&lt;span&gt;2&lt;/span&gt;]. Was subgroup pooling by ejection-fraction phenotype, say, or follow-up length genuinely not feasible here, or just not attempted?&lt;/p&gt;&lt;p&gt;The headline numbers are the best-case ones. The abstract leads with HR 3.28 for HFpEF mortality and OR 2.47 for 1-month MACE, but doesn't mention that both come from small, single studies rated very-low certainty; the MACE figure rests on just 96 patients, with a confidence interval (1.01–6.01) that barely clears the null. Meanwhile, the null results reported in the body of the paper 2-month rehospitalization, AKI, eGFR, don't make it into the abstract at all. Boutron et al. gave this pattern a name in their landmark study of trial abstracts: spin [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The AUCs and the framing don't match. Reported AUCs of 0.56–0.62 are barely better than a coin flip, yet the Discussion still positions BCR as a promising low-cost alternative to NT-proBNP, troponin, and ST2. If BCR's clinical utility is going to be discussed, those AUC values deserve equal billing.&lt;/p&gt;&lt;p&gt;Some certainty ratings look inflated. Several Table 4 outcomes are graded moderate-to-high certainty despite resting on a single observational study which, under GRADE, starts at low certainty by default [&lt;span&gt;4&lt;/span&gt;]. It would help to know explicitly which upgrading criteria were invoked (large effect? dose−response? confounding working against the association?).&lt;/p&gt;&lt;p&gt;Going forward, we'd like to see biomarker reviews report certainty-weighted summaries directly in the structured abstract, and flag analytical-plan deviations up front in line with PRISMA 2020 [&lt;span&gt;5&lt;/span&gt;]. None of this undercuts the value of the review: BCR still looks like a promising, low-cost marker of hemodynamic and renal stress. We just think its discriminative limits deserve the same prominence as its associations, since for most clinicians, the abstract is all they'll ever read.&lt;/p&gt;&lt;p&gt;We thank the authors and welcome continued dialogue.&lt;/p&gt;&lt;p&gt;The authors have read and approve","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 8","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599908","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 of Mechanical Circulatory Support With In-Hospital Outcomes in Non-Ischemic Cardiogenic Shock: A Nationwide Inpatient Study","authors":"Li Liu,&nbsp;Burhan Memon,&nbsp;Tian Zou,&nbsp;Wiaam Elkhatib,&nbsp;Pincheng Luo,&nbsp;Laura E. Billstein,&nbsp;Nomesh Kumar,&nbsp;Youyou Cheng,&nbsp;Abigail Fickel,&nbsp;Shengtong Shao,&nbsp;Maya Guglin,&nbsp;Chenyu Sun","doi":"10.1002/clc.70416","DOIUrl":"10.1002/clc.70416","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiogenic shock (CS) carries high morbidity and mortality. However, evidence for mechanical circulatory support (MCS) in non-ischemic CS remains limited, as prior trials have focused on infarct-related shock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cross-sectional study using the Nationwide Inpatient Sample (2017–2019), identifying hospitalizations with a principal diagnosis of CS and excluding acute myocardial infarction. Patients were categorized into mutually exclusive groups: no MCS, intra-aortic balloon pump (IABP) only, Impella only, or extracorporeal membrane oxygenation (ECMO) only. Primary outcomes were in-hospital mortality, length of stay (LOS), and total hospital cost. Survey-weighted multivariable models adjusted for demographics, hospital characteristics, and comorbidity burden using Elixhauser and Charlson indices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 104 045 hospitalizations, 6040 received MCS. IABP was most common, followed by Impella and ECMO. Among patients receiving a single MCS strategy, overall in-hospital mortality was 29.5%., with lower mortality in the IABP group (19.9%) compared with Impella (37.4%) and ECMO (44.3%). After adjustment, IABP was associated with lower observed in-hospital mortality versus no MCS (aOR 0.58, 95% CI 0.53–0.64; <i>p</i> &lt; 0.01), whereas Impella and ECMO showed increased aOR. IABP and ECMO were associated with longer LOS, while Impella was not. All MCS strategies were associated with higher costs, with ECMO showing the greatest increase (cost ratio 3.30, 95% CI 3.12–3.50).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In non-ischemic CS, MCS strategies demonstrate distinct profiles of mortality and resource utilization. IABP was associated with lower observed in-hospital mortality, whereas all MCS were linked to higher costs, highlighting heterogeneity in outcomes and the need for further research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560921","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":"Artificial Intelligence-Based Analysis of Coronary Atherosclerotic Plaque on Intravascular Ultrasound: A Systematic Review and Meta-Analysis","authors":"Pooya Eini,&nbsp;Homa Serpoush,&nbsp;Mohammad Rezayee,&nbsp;Milan Kassulke","doi":"10.1002/clc.70423","DOIUrl":"10.1002/clc.70423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary atherosclerotic plaque detection is essential for the diagnosis and management of coronary artery disease. Although intravascular ultrasound (IVUS) enables detailed plaque assessment, its clinical use is limited by time-consuming interpretation and observer variability. Artificial intelligence (AI)-based methods offer a promising approach to automate IVUS plaque detection. This systematic review and meta-analysis evaluated the diagnostic performance of AI models for IVUS-based coronary plaque detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted across major databases from inception to December 2025. Data extraction and risk of bias assessment were performed independently using the PROBAST-AI tool. Pooled sensitivity and specificity were estimated using bivariate random-effects models, and sources of heterogeneity were explored through meta-regression. Certainty of evidence was assessed using the GRADE framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 10 included studies (six for meta-analysis), the pooled sensitivity and specificity were both 0.99 (95% CI, 0.93–1.00 and 0.96–1.00, respectively), with an area under the summary receiver operating characteristic curve of 1.00 (95% CI, 0.99–1.00). Moderate between-study heterogeneity was observed (generalized <i>I</i>² = 46.1%), affecting both sensitivity and specificity. Meta-regression analyses identified sample size as a significant contributor to heterogeneity. Risk of bias assessment revealed a moderate overall risk, and the certainty of evidence was rated as moderate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI-based IVUS analysis shows promising performance for automated plaque and calcification assessment in research settings. However, limitations related to study design, sample size, and reporting transparency remain. Future research should prioritize large, multicenter, prospective studies and strict adherence to TRIPOD + AI guidelines to support clinical translation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535439","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":"Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study","authors":"Josephine Sikulu,&nbsp;Ralf Kubini,&nbsp;Muath Turkman,&nbsp;Moritz Benjamin Immohr,&nbsp;Michael Becker,&nbsp;Rashad Zayat,&nbsp;Ali Aljalloud","doi":"10.1002/clc.70424","DOIUrl":"10.1002/clc.70424","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary vasomotor disorders are frequently underdiagnosed in women with angina and non-obstructive coronary arteries. We investigated clinical presentation, diagnostic delay, spasm subtype, and patient-reported treatment response in women with acetylcholine-confirmed coronary spasm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center observational study included women with a positive intracoronary acetylcholine provocation test who completed a locally developed questionnaire on symptoms, triggers, comorbidities, medication tolerance, and treatment response. Epicardial spasm was defined as ≥ 90% epicardial diameter reduction with symptom reproduction and ischemic ECG changes; microvascular spasm as symptoms and ischemic ECG changes with &lt; 90% epicardial vasoconstriction. Diltiazem was initiated as first-line therapy, with amlodipine as an alternative. Regression analyses exploring therapeutic failure were considered exploratory because of the low event count.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 194 women were included (median age 60 years [IQR 52–67]). Chest pain/tightness was reported by 163/190 (85.8%), dyspnea by 70/135 (51.9%), and palpitations by 74/136 (54.1%). Epicardial/microvascular spasm was present in 110/187 (58.8%) and 77/187 (41.2%). Median symptom-to-diagnosis time was 24 months [IQR 8–90]. Diltiazem was prescribed in 162/194 (83.5%). Among respondents with follow-up data, symptom frequency decreased in 103/128 (80.5%), episode duration decreased in 91/118 (77.1%), and pain intensity decreased/resolved in 92/115 (80.0%). Therapeutic failure occurred in 8/106 (7.5%). Residual symptom burden remained common, with CCS class &gt; II at follow-up in 65/124 (52.4%) and persistent complaints in 53/107 (49.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In women with acetylcholine-confirmed coronary spasm, symptom burden and diagnostic delay were substantial. Calcium-channel blocker therapy was associated with patient-reported symptom improvement among respondents with available follow-up data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535472","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":"Spontaneous Coronary Reperfusion in STEMI After Pre-Hospital Loading Dose of Triple Antithrombotic Therapy","authors":"Pierre Alain Meunier,&nbsp;Lea Juenin,&nbsp;Lionel Moulis,&nbsp;François Roubille,&nbsp;Pierre Robert,&nbsp;Jean Christophe Macia,&nbsp;Jean-Michel Berdeu,&nbsp;Matthieu Steinecker,&nbsp;Benoit Lattuca,&nbsp;Laurent Schmutz,&nbsp;Luc Cornillet,&nbsp;Guillaume Cayla,&nbsp;Florence Leclercq","doi":"10.1002/clc.70418","DOIUrl":"https://doi.org/10.1002/clc.70418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To evaluate the incidence and prognosis of spontaneous coronary reperfusion in STEMI using pre-hospital loading dose of P2Y12 inhibitors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective bi-centric study included STEMI patients who referred for primary PCI from June 1, to November 1, 2022. All patients received before hospital admission loading dose of aspirin, heparin and P2Y₁₂ inhibitor. The primary outcome was incidence of spontaneous coronary reperfusion (TIMI 3 flow) before primary PCI. Major in-hospital and 1-year events were secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Within the study period, 263 patients were admitted with ongoing STEMI and 49 of them (18.6%) had spontaneous coronary reperfusion with no significant difference between loading dose of ticagrelor (<i>n</i> = 226; 85.9%) or clopidogrel (<i>n</i> = 27, 10.3%) and TIMI 3 flow (<i>n</i> = 41; 18.1% vs. <i>n</i> = 7; 25.9%, <i>p</i> = 0.53; respectively). Peak of T-hs troponin (<i>p</i> &lt; 0.001) and CRP (<i>p</i> = 0.03) were significantly lower in the TIMI 3 group. In multivariate analysis, out-of- hospital cardiac arrests were observed twice as often in the TIMI 3 group (16.33 vs. 7.01%; <i>p</i> = 0.044). There was no significant difference between the two groups regarding major in-hospital (<i>p</i> = 0.69) or 1-year major events (<i>p</i> = 0.20).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Spontaneous reperfusion at admission was observed in about 20% of STEMI patients who received a pre-hospital loading dose of antithrombotic therapy including P2Y₁₂ inhibitors, and was associated with markers of decrease of infarct size. The significant increase of pre-admission cardiac arrests observed in the TIMI 3 group could be specifically explored as it might be a concern regarding future pre-hospital reperfusion therapy strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467181","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":"Echocardiographic Probability of Pulmonary Hypertension, Cardiac Structural Alterations and All-Cause Mortality in Maintenance Hemodialysis Patients: A Single-Center Retrospective Cohort Study With Competing Risk Analysis","authors":"Jingwen Zhou,&nbsp;Zhenhua Yang,&nbsp;Dongmei Huo","doi":"10.1002/clc.70415","DOIUrl":"https://doi.org/10.1002/clc.70415","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Maintenance hemodialysis (MHD) patients carry extremely high cardiovascular mortality, where pulmonary hypertension (PH) and vascular access are critical prognostic factors. However, previous survival studies seldom considered renal transplantation as a competing event, potentially biasing risk factor estimates, and the heterogeneity of mortality predictors across vascular access subtypes remains unclear. This study aimed to evaluate whether echocardiographic probability of PH is independently associated with all-cause mortality in MHD patients using a competing risk model. Secondary objectives included identifying additional clinical and echocardiographic predictors of mortality and comparing survival between vascular access types. Exploratory subgroup analyses by vascular access and construction of a nomogram were also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort enrolled 749 MHD patients from the First Affiliated Hospital of Guangxi Medical University between May 2010 and May 2022. All-cause mortality was the primary endpoint, with renal transplantation as the competing event. Independent predictors were identified via the Fine-Gray model, and subgroup analyses were performed by tunneled cuffed catheter (TCC) and arteriovenous fistula/graft (AVF/AVG).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During follow-up, 274 deaths and 64 renal transplantations occurred. Intermediate/high probability of PH, age, left atrial diameter, and right ventricular diameter (RVD) independently predicted mortality. Subgroups showed age and high PH predicted death in TCC patients, whereas age, intermediate/high PH, and RVD predicted death in AVF/AVG patients. No survival difference was found between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PH severity, age, and cardiac structural remodeling are independent mortality risk factors in MHD patients. Risk predictors vary by vascular access, and individualized cardiovascular stratification may improve long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467127","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":"Epidemiological Trends in Mortality From Acute Myocardial Infarction With Essential and Secondary Hypertension: CDC WONDER Database Analysis, 2000–2024","authors":"Javeria Akhter,&nbsp;Waleed Ahmad,&nbsp;Aasiya Shahbaz,&nbsp;Aniqa Dejwani,&nbsp;Nafila Zeeshan,&nbsp;Jamil Nasrallah","doi":"10.1002/clc.70420","DOIUrl":"https://doi.org/10.1002/clc.70420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute myocardial infarction (AMI) with essential hypertension (EH) and secondary hypertension (SH) remains a leading cause of mortality. Despite the overall decline, disparities in mortality trends across age group, gender, urbanization, racial, and regional subgroups remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mortality data from the CDC WONDER (2000–2024) were analyzed for AMI (ICD-10 I21) as the primary cause of death and EH (ICD-10 I10) and SH (ICD-10 I15.0, I15.9) as a contributing factor in individuals aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) were standardized to the US 2000 population. Joinpoint regression estimated annual percentage changes (APCs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AMI with hypertension caused 842,646 deaths, with AAMR declining from 17.63 in 2000 to 12.26 in 2024. Overall, the AAMR showed a significant decline across the study period (AAPC: −1.71%). Males consistently had a higher mean AAMR (18.50) than females (11.82). Upward inflections were noted in the South region during 2018–2021 (APC: 11.17%; <i>p</i> = 0.004), Non-Hispanic Black individuals during 2018–2021 (APC: 9.45%; <i>p</i> = 0.053), metropolitan areas during 2018–2020 (APC: 7.71%; <i>p</i> = 0.038), and among adults aged 65–74 years during 2018–2021 (APC: 7.15%; <i>p</i> = 0.039). State-level variations were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the overall decline, rising mortality trends were observed in the Southern region (2018–2021), metropolitan areas, and among individuals aged 65–74 years, highlighting emerging patterns and emphasizing the need for targeted interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467180","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":"Temporal Trends and Disparities in Hypertension-Related Cardiomyopathy Mortality in the United States, 1999–2023","authors":"Javeria Akhter,&nbsp;Iqra Taj,&nbsp;Muhammad Umar,&nbsp;Abdulrahman Nasir Al Khatib,&nbsp;Jamil Nasrallah","doi":"10.1002/clc.70417","DOIUrl":"https://doi.org/10.1002/clc.70417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension and cardiomyopathy are major contributors of cardiovascular morbidity in the United States. This study investigates long-term mortality trends and disparities in hypertension-related cardiomyopathy from 1999 to 2023 in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mortality data from CDC WONDER (1999–2023) were evaluated for cardiomyopathy (ICD-10 I42, I42.2, and I42.9) as the primary cause of death and hypertension (ICD-10 I10, I15.0 and I15.9) as a contributing cause among individuals aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) were standardized to the United States 2000 population. Joinpoint regression estimated annual percent change (APC) with 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2023, 153 563 deaths were identified. AAMR increased from 1.26 per 100 000 in 1999 to 2.22 in 2023, driven by a significant early rise from 1999 to 2001 (APC: +30.33; <i>p</i> &lt; 0.005). Males had higher mortality than females (2.98 vs. 1.61) with males declining significantly from 2001 to 2023 (APC: −0.64; <i>p</i> &lt; 0.005). NH Black individuals had the highest AAMR (10.81), followed by NH White individuals (5.02). Mortality was higher in non-metropolitan than metropolitan areas (2.71 vs. 2.26), both declining significantly after 2001 (APC: −0.89; −1.69; <i>p</i> &lt; 0.005). South had the highest burden (AAMR: 4.86), while the Midwest rose significantly after 2017 (APC: +4.11; <i>p</i> &lt; 0.005). Adults aged ≥ 85 years had the highest mortality (CMR: 32.79) increasing significantly after 2015 (APC: +2.44 <i>p</i> &lt; 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hypertension-related cardiomyopathy mortality rose sharply in 1999–2001 before declining through 2023, with persistent disparities by sex, race, geography, and age. Targeted hypertension control and equitable cardiovascular care remain needed to reduce this burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"49 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467452","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}