Clinical Cardiology最新文献

{"title":"Association Between Changes in Heart Rate and Adverse Events in Patients With Non-Valvular Atrial Fibrillation: A Post Hoc Analysis of the J-RHYTHM Registry","authors":"Eitaro Kodani,&nbsp;Takeshi Yamashita,&nbsp;Hiroshi Inoue,&nbsp;Hirotsugu Atarashi,&nbsp;Ken Okumura,&nbsp;Hideki Origasa,&nbsp;J-RHYTHM Registry Investigators","doi":"10.1002/clc.70122","DOIUrl":"https://doi.org/10.1002/clc.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We previously reported that the heart rate (HR) at the time closest to an event or at the last visit during the follow-up period (HR-end) was more closely associated with adverse events (AEs) than baseline HR in patients with non-valvular atrial fibrillation (NVAF). However, it remains uncertain whether changes in HR during the follow-up period or absolute HR values would be more closely associated with AEs. Thus, we performed post hoc analyses using data from the J-RHYTHM Registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of 7406 outpatients with NVAF from 158 institutions, 6886 (age, 69.8 ± 9.9 years; men, 70.8%), who had both baseline HR and HR-end data, were included. Patients were divided into five groups based on the changing patterns of HR quartiles from baseline (&lt; 63, 63–70, 71–79, and ≥ 80 beats per minute) to the end of follow-up (no-change, down-to-the-lowest-quartile, down-to-the-2nd or -3rd-quartile, up-to-the-2nd or -3rd-quartile, and up-to-the-highest-quartile).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Hazard ratios for AEs were significantly higher only in the up-to-highest-quartile group (2.89 [95% confidence interval, 1.71–4.90] for thromboembolism, 2.46 [1.53–3.95] for major hemorrhage, and 2.36 [1.51–3.70] for all-cause death) compared with the no-change group, after adjusting for confounding factors. Furthermore, in the no-change group, hazard ratios for AEs were significantly higher in the highest-to-highest-quartile subgroup (5.55 [1.49–20.77] for major hemorrhage and 3.60 [1.03–12.53] for all-cause death) compared with the 2nd-to-2nd-quartile subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both excessive increases in HR and consistently high HR were independently associated with AEs in patients with NVAF. By contrast, modest decrease in HR during follow-up was associated with lower mortality. Accordingly, it is important to pay attention to changes in HR during follow-up for the management of patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Registration</h3>\u0000 \u0000 <p>The J-RHYTHM Registry is registered in the University Hospital Medicine Information Network (UMIN) Clinical Trials Registry (unique identifier: UMIN000001569) http://www.umin.ac.jp/ctr/.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707638","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":"Exercise-Based Cardiac Rehabilitation for Patients After Heart Valve Surgery: A Systematic Review and Re-Evaluation With Evidence Mapping Study","authors":"Rongxiang Zhang,&nbsp;Chenyang Zhu,&nbsp;Shiqi Chen,&nbsp;Feng Tian,&nbsp;Yuan Chen","doi":"10.1002/clc.70117","DOIUrl":"https://doi.org/10.1002/clc.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review and evidence mapping study aims to assess the effects of exercise-based cardiac rehabilitation on clinical outcomes in patients after heart valve surgery. By consolidating and visualizing existing evidence, the study seeks to identify gaps in knowledge, evaluate the quality and breadth of current research, and provide guidance for clinical practice and future research. The evidence mapping will highlight under-researched areas and inform healthcare providers on effective strategies to enhance postoperative recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search was performed across multiple databases, including PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, and Wanfang, up to May 2024. Two reviewers independently screened the articles, extracted relevant data, and assessed study quality. Study characteristics and outcomes were visualized using bubble plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten systematic reviews/meta-analyses met the inclusion criteria. Based on AMSTAR-2, two were rated “high quality,” two “low quality,” and six “very low quality.” Using the GRADE system, of the 48 pieces of evidence across 10 outcomes, 1 was “high quality,” 8 “moderate,” 19 “low,” and 20 “very low.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current evidence indicates that exercise-based cardiac rehabilitation can enhance physical capacity, left ventricular ejection fraction, peak oxygen uptake, and daily living activities in heart valve surgery patients. However, more large-scale, high-quality studies are needed to verify its effects on all-cause mortality, quality of life, adverse events, return to work, and emotional health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689770","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 Outcomes and Prognostic Implications of TAVR in Patients With Active Cancer: A Meta-Analysis","authors":"Parsa Saberian,&nbsp;Rafael Contreras,&nbsp;Anoop Gurram,&nbsp;Amir Nasrollahizadeh,&nbsp;Narsimha Rao Keetha,&nbsp;Anthony Loc Nguyen,&nbsp;Sandeep Samethadka Nayak,&nbsp;Mohammad-Hossein Keivanlou,&nbsp;Mohammad Hashemi,&nbsp;Ehsan Amini-Salehi,&nbsp;Daniyal Ameen","doi":"10.1002/clc.70121","DOIUrl":"https://doi.org/10.1002/clc.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for high-risk patients with severe aortic stenosis (AS). However, the clinical outcomes and prognostic implications of TAVR in patients with active cancer remain uncertain. This meta-analysis evaluates procedural success, complications, and survival outcomes of TAVR in patients with and without active cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases. Statistical analysis was performed using a random-effects model. Statistical analyses were conducted using STATA version 18.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results of the meta-analysis showed no significant difference in in-hospital mortality between cancer and non-cancer patients (OR = 1.17; 95% CI: 0.83, 1.65; <i>p</i> = 0.27). Similarly, 30-day mortality did not differ between the two groups (OR = 0.93; 95% CI: 0.72, 1.19; <i>p</i> = 0.49). However, 1-year mortality was significantly higher in cancer patients (OR = 1.93; 95% CI: 1.45, 2.56; <i>p</i> &lt; 0.01). Two-year mortality was also higher in cancer patients (OR = 2.65; 95% CI: 1.79, 3.93; <i>p</i> &lt; 0.01). No significant differences were observed in major bleeding, acute kidney injury, stroke, or permanent pacemaker implantation between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While TAVR offers comparable in-hospital and short-term survival outcomes for cancer and non-cancer patients, long-term mortality is significantly higher in those with active cancer. These findings suggest that TAVR is a viable option for cancer patients with severe AS but requires careful long-term prognostic considerations. Further studies are needed to optimize management strategies for this complex population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689957","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":"Frequency and Impact of Cardiology Evaluation Following Perioperative Myocardial Infarction","authors":"Anthony Hung,&nbsp;R. Parker Ward,&nbsp;Daniel S. Rubin","doi":"10.1002/clc.70120","DOIUrl":"10.1002/clc.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Perioperative myocardial infarction (PMI) after noncardiac surgery results in significant morbidity and mortality. While comprehensive management, including imaging and guideline-directed medical therapy (GDMT), improves outcomes, utilization of these strategies and the impact of physician evaluation on their utilization are unknown. This study evaluates the frequency of cardiology evaluation after PMI and its association with guideline-recommended care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using IBM MarketScan (2016–2021), we analyzed claims for patients ≥ 45 years old with PMI during or after major noncardiac surgery. We examined the relationship between cardiology evaluation and post-PMI care using three regression models: (1) a Poisson model for GDMT class prescriptions filled within 3 months post-discharge, and logistic models for (2) ischemic testing and (3) echocardiography during hospitalization or within 3 months post-discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5660 patients with PMI (mean age 68, 56.9% male, 27.2% with STEMI), 19% were not evaluated by a cardiologist. Patients with cardiology evaluation were more likely to receive at least one GDMT prescription after PMI (78.8% vs 74.0%, <i>p</i> &lt; 0.001). Cardiology evaluation was also associated with an increased likelihood of ischemic testing (38.2% vs 23.0%, <i>p</i> &lt; 0.001) and echocardiography (75.9% vs 53.6%, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>One in five PMI patients lacks cardiology evaluation, and evaluation is associated with an increased likelihood of recommended management after PMI. Future studies should explore whether cardiology evaluation and management strategies impact patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673420","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":"Atrial Fibrillation and Heart Failure: Synergistic Effect on Functional Class and Quality of Life","authors":"Sofía Zapata,&nbsp;Maria F. Colorado,&nbsp;Andrés Medina,&nbsp;Jaime A. Mejía,&nbsp;Sofia Betancur,&nbsp;Johanna M. Vanegas,&nbsp;James S. Díaz","doi":"10.1002/clc.70113","DOIUrl":"10.1002/clc.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) and heart failure (HF) are highly prevalent conditions associated with significant morbidity and symptom burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study compared the evolution over time of functional class and quality of life (QoL) in patients with HF according to the presence of AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted at an outpatient heart failure clinic in Colombia, between 2020 and 2022. Functional class (based on the New York Heart Association classification) and QoL (measured by the Minnesota Living with Heart Failure Questionnaire), were analyzed at baseline, 3 months, 6 months, and the last visit. The simultaneous impact of AF and left ventricular ejection fraction was analyzed using a generalized estimation equation model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 440 patients (median age 74 years, 56.6% men), 41.4% with AF, and 65.2% with reduced ejection fraction (HFrEF). Over time, functional class improved in both groups, with a more significant improvement in patients without AF. Patients with AF and HFrEF were more likely to remain in worse functional classes (OR: 2.77; 95% CI: 1.37–5.62). Similar trends were observed in QoL questionnaire, with sustained improvement after 3 months. However, AF negatively affected the physical dimension in patients with HFrEF, increasing the QoL questionnaire score by up to 4%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of AF and reduced ejection fraction was associated with a lesser improvement in functional class and physical dimension of QoL questionnaire, emphasizing the importance of early detection and management of AF as part of comprehensive HF care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662419","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":"Long-Term Effects of Left Bundle Branch Area Pacing Versus Traditional Right Ventricular Pacing on Atrial Fibrillation After Dual-Chamber Pacemaker Implantation","authors":"Jieruo Chen,&nbsp;Zefeng Wang,&nbsp;Fei Hang,&nbsp;Weiping Sun,&nbsp;Haiwei Li,&nbsp;Yongquan Wu","doi":"10.1002/clc.70116","DOIUrl":"https://doi.org/10.1002/clc.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traditional right ventricular pacing (RVP) can lead to asynchronous cardiac mechanical contractions and increase the risk of atrial fibrillation (AF). This study aimed to compare the occurrence of new-onset AF and the progression of AF between novel physiological pacing—left bundle branch area pacing (LBBAP) and RVP with a long-term follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Patients with a dual-chamber permanent pacemaker initial implantation, no history of persistent AF, and an expected high proportion of ventricular pacing (VP ≥ 20%) were included in this retrospective cohort study (LBBAP, <i>n</i> = 122; RVP, <i>n</i> = 166). The pacing QRS duration (QRSd) of the LBBAP was significantly shorter than that of the RVP (113 ± 22 vs. 140 ± 27 ms, <i>p</i> &lt; 0.001), while the intrinsic QRSd values from the two groups were comparable. During a mean follow-up of 21.9 ± 9.4 months, the composite outcome of postoperative new-onset AF or AF progression was higher in the RVP group than in the LBBAP group (RVP HR 2.62, 95%CI 1.21–5.67, <i>p</i> = 0.014). Left ventricular end-diastolic diameter (LVEDD) levels decreased in the LBBAP group at 1 year follow-up (50 ± 6 vs. baseline 48 ± 6, <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a mean follow-up period of 2 years, compared to RVP, LBBAP patients with VP ≥ 20% had a decreased risk of occurrence and progression of AF events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639001","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 Prognostic Value of Platelet-Albumin-Bilirubin Score in Patients Undergoing Transcatheter Aortic Valve Replacement","authors":"Farman Ullah Khan,&nbsp;Muhammad Ammar ul hassan khan,&nbsp;Muhammad Aamir khan,&nbsp;Shad Khan,&nbsp;Muhammad Ismail","doi":"10.1002/clc.70119","DOIUrl":"https://doi.org/10.1002/clc.70119","url":null,"abstract":"<p>We read with great interest the article “The Prognostic Value of Platelet-Albumin-Bilirubin Score in Patients Undergoing Transcatheter Aortic Valve Replacement.” by Duan et al. [<span>1</span>]. Reading such a well-written and complete piece is satisfying and the author's efforts on this important subject must be acknowledged. This study comprehensively evaluates the predictive efficacy of the platelet-albumin-bilirubin (PALBI) score for mortality in patients having transcatheter aortic valve replacement (TAVR), as well as its significance for enhancing risk classification alongside the Society of Thoracic Surgeons (STS) score. Although the research provides significant insights, some aspects demand further consideration and discussion.</p><p>First of all, this study only used the PALBI score, which includes platelet count, albumin, and bilirubin, in assessing liver function in TAVR patients. However, it did not consider other liver prognostic models, such as the Child-Pugh (CP) and Model for End-Stage Liver Disease (MELD) scores, which involve biomarkers such as creatinine and INR. A multicenter study found that using various hepatic prognostic models can improve outcome prediction in TAVR patients [<span>2</span>].</p><p>Additionally, this investigation excluded significant comorbidities that have reduced the PALBI score's predictive validity, including frailty, systemic inflammation, malnutrition, and anticoagulant treatment. These factors significantly affect albumin and platelet counts, which could reduce PALBI's precision as a predictor. By incorporating these variables into multivariate models, PALBI's feasibility as an independent predictor of TAVR-related mortality would be strengthened. The 2018 study found that comorbid conditions like malnutrition significantly affect TAVR outcomes. In TAVR patients, low serum albumin, a gauge of both malnutrition and frailty, has been associated with a higher 30-day mortality rate and more postoperative complications [<span>3</span>].</p><p>Furthermore, the PALBI score may not provide a complete risk assessment for patients undergoing TAVR because it does not account for key cardiac-specific factors such as left ventricular ejection fraction (LVEF), aortic valve gradient (AVG), or the presence of coronary artery disease. Relying only on the PALBI score ignoring these key cardiac characteristics may result in an inadequate assessment of patient risk, thus limiting its predictive accuracy in TAVR populations. Reduced LVEF and low AVG are substantially related with poor post-TAVR outcomes, with low AVG providing as a significant predictor of mortality [<span>4</span>].</p><p>This study does not include people with chronic liver illness, end-stage renal disease (ESRD), and dialysis, limiting its credibility. These high-risk patients typically have poor post-TAVR outcomes, their exclusion may underestimate PALBI's true prognostic value in real-world circumstances. Chronic kidney disease (CKD) and ESRD ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143638797","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":"National Trends in Mortality Due to Ischemic Stroke Among Older Adults With Atrial Fibrillation in the USA, 1999–2020","authors":"Saeed Aftab Khan,&nbsp;Arfa Ahmed Assad,&nbsp;Hamza Ashraf,&nbsp;Hanzala Ahmed Farooqi,&nbsp;Sabahat Ul Ain Munir Abbasi,&nbsp;Hira Saleem,&nbsp;Reyan Khalid,&nbsp;Aala Saleh,&nbsp;Muhammad Hashim Akram","doi":"10.1002/clc.70115","DOIUrl":"https://doi.org/10.1002/clc.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is a significant contributor to ischemic stroke risk and mortality, particularly in aging populations. This study examines mortality trends from ischemic stroke secondary to AF in the U.S. from 1999 to 2020, focusing on demographic and regional disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the CDC WONDER database, this cross-sectional analysis included individuals aged ≥ 65 years with death certificates indicating ischemic stroke (ICD I63) and AF (ICD I48) as contributing causes. Age-adjusted mortality rates (AAMR) were calculated, and temporal trends were analyzed using join-point regression to estimate annual percentage changes (APC). Data were stratified by age, sex, race/ethnicity, urbanization, and geographic regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, ischemic stroke with AF caused 62,443 deaths (AAMR: 6.75/100,000; 95% CI: 6.70–6.80). Mortality rates increased significantly after 2010, peaking between 2014 and 2017 (APC: 31.3 for females, 28.1 for males). Older adults (≥ 85 years) exhibited the highest AAMR (43.2/100,000; 95% CI: 41.6–44.8). Nonmetropolitan areas consistently showed higher mortality compared to metropolitan regions. Demographic disparities were evident, with higher AAMRs in females, Whites, and the Western U.S., though Hispanics had the sharpest APC increase during 2014–2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mortality rates from ischemic stroke with AF are rising in older adults, with significant demographic and regional disparities. The findings underscore the need for targeted public health strategies to mitigate AF-related stroke risks and improve healthcare equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622663","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 Outcomes of Immediate Versus Staged Revascularization of Nonculprit Arteries in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis","authors":"Farah Yasmin,&nbsp;Syeda Farwa Zaidi,&nbsp;Abdul Moeed,&nbsp;Maryam Shahzad,&nbsp;Muhammad Sohaib Asghar,&nbsp;Mahnoor Sadiq,&nbsp;Javed Iqbal,&nbsp;Salim Surani,&nbsp;M. Chadi Alraies","doi":"10.1002/clc.70105","DOIUrl":"https://doi.org/10.1002/clc.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent guidelines for acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD) recommend revascularization of non-culprit lesions following primary percutaneous coronary intervention (PCI). However, the optimal timing for this procedure—whether immediate or staged—remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search using PubMed (MEDLINE), Cochrane Central, and Google Scholar was conducted to identify studies comparing clinical outcomes between immediate and staged revascularization approaches in patients with MVD undergoing PCI. A random effects model was used to calculate risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). The primary outcome was 1-year all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 10 randomized controlled trials (RCTs), comprising 3886 patients (1964 in the immediate revascularization group and 1940 in the staged revascularization group), with a median follow-up of 12 months, were included in the analysis. No significant difference in the risk of 1-year mortality was noted between the two approaches. The risk of target vessel revascularization (TVR) at 1-year follow-up was significantly lower in the immediate revascularization group compared to the staged revascularization group (RR: 0.64; 95% CI: 0.47–0.86; I²: 0%; <i>p</i> = 0.03). Additionally, the immediate revascularization group had a significantly lower risk of myocardial infarction (MI) at 1-year follow-up than the staged approach (RR: 0.57; 95% CI: 0.37–0.88; I²: 10%; <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This meta-analysis suggests that immediate revascularization is associated with a significantly lower risk of TVR and MI at 1-year compared to staged revascularization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595331","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":"Urgent Transcatheter Mitral Edge-to-Edge Repair Is Associated With Worse in-Hospital Outcomes: A Nationwide Analysis","authors":"Carlos Diaz-Arocutipa,&nbsp;Cesar Joel Benites-Moya,&nbsp;Javier Torres-Valencia,&nbsp;Adhya Mehta,&nbsp;Lourdes Vicent","doi":"10.1002/clc.70067","DOIUrl":"https://doi.org/10.1002/clc.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To assess in-hospital outcomes in patients undergoing urgent versus non-urgent transcatheter mitral edge-to-edge repair (TEER).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the NIS database 2016−2019 to include admissions who underwent TEER. Inverse probability of treatment weighting (IPTW) was used to compare urgent versus non-urgent groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 29 730 weighted admissions were included, of whom 21.6% were urgent admissions. Urgent admissions had a higher risk of in-hospital mortality (risk ratio [RR] 3.67, 95% confidence interval [CI] 2.39−5.62), cardiogenic shock (RR 4.95, 95% CI 3.73−6.57), intra-aortic balloon pump (RR 3.97, 95% CI 2.53−6.23), percutaneous ventricular assist device (RR 17.24, 95% CI 6.37−46.66), mechanical ventilation (RR 3.79, 95% CI 2.80−5.11), acute stroke (RR 2.56, 95% CI 1.32−4.97), in-hospital cardiac arrest (RR 2.25, 95% CI 1.08−4.69), major bleeding (RR 5.18, 95% CI 2.97−9.06), increased length of stay (6 vs. 2 days, <i>p</i> &lt; 0.001), and higher total costs ($229 160 vs. $164 653, <i>p</i> &lt; 0.01) compared to non-urgent admissions. There was no difference between both groups for renal replacement therapy and pericardial complication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that urgent TEER implantation was associated with an increased risk of in-hospital death and other short-term complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594917","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}