Clinical Research in Cardiology最新文献

{"title":"Global longitudinal strain in long-term risk prediction after acute coronary syndrome: an investigation of added prognostic value to ejection fraction.","authors":"Joel Lenell, Bertil Lindahl, David Erlinge, Tomas Jernberg, Jonas Spaak, Tomasz Baron","doi":"10.1007/s00392-024-02439-w","DOIUrl":"10.1007/s00392-024-02439-w","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to investigate the additional value of global longitudinal strain (GLS) on top of left ventricular ejection fraction (LVEF) in long-term risk prediction of combined death and heart failure (HF) re-hospitalization after acute coronary syndrome (ACS).</p><p><strong>Method and results: </strong>This retrospective study included patients admitted with ACS between 2008 and 2014 from the three participating university hospitals. LVEF and GLS were assessed at a core lab from images acquired during the index hospital stay. Their prognostic value was studied with the Cox proportional hazards model (median follow-up 6.2 years). A nested model comparison was performed with C-statistics. A total of 941 patients qualified for multivariable analysis after multiple imputation of missing baseline covariables. The combined outcome was reached in 17.7% of the cases. Both GLS and LVEF were independent predictors of the combined outcome, hazard ratio (HR) 1.068 (95% CI 1.017-1.121) and HR 0.980 (95% CI 0.962-0.998), respectively. The C-statistic increased from 0.742 (95% CI 0.702-0.783) to 0.749 (95% CI 0.709-0.789) (P = 0.693) when GLS entered the model with clinical data and LVEF.</p><p><strong>Conclusion: </strong>GLS emerged as an independent long-term risk predictor of all-cause death and HF re-hospitalization. However, there was no significant incremental predictive value of GLS when LVEF was already known.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"709-718"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atorvastatin versus rosuvastatin in acute myocardial infarction with elevated liver enzymes: a target trial emulation study.","authors":"Xiaozhi Chen, Hangkuan Liu, Linjie Li, Geru A, Pengfei Sun, Doreen Su-Yin Tan, Mark Yan-Yee Chan, Roger Sik-Yin Foo, Gregg C Fonarow, Qing Yang, Xin Zhou","doi":"10.1007/s00392-025-02645-0","DOIUrl":"10.1007/s00392-025-02645-0","url":null,"abstract":"<p><strong>Background: </strong>Statins are associated with liver-related adverse events, with risk varying by statin type. However, current guidelines lack specific recommendations for statin selection in acute myocardial infarction (AMI) patients with elevated liver enzymes.</p><p><strong>Methods: </strong>This cohort study used a target trial emulation approach to include AMI patients treated with percutaneous coronary intervention between 2013 and 2022 from the Tianjin Health and Medical Data Platform, China. Eligible patients with atorvastatin or rosuvastatin prescriptions during hospitalization were matched 1:1 using propensity scores in those with elevated liver enzymes and normal liver enzymes respectively, and tracked for 1 year or until death (intention-to-treat analysis). Nonadherent patients were censored in the per-protocol analysis. The primary outcome was 1-year all-cause mortality, with secondary outcomes including recurrent MI and stroke.</p><p><strong>Results: </strong>In a matched cohort of 25,728 patients with elevated liver enzymes, 614 deaths (2.4%) occurred. Atorvastatin was associated with higher all-cause mortality compared to rosuvastatin (hazard ratio [HR]: 1.29, 95% confidence interval [CI] 1.10-1.51), consistent in the per-protocol analysis, and the in-hospital mortality difference was confirmed in an independent cohort. No significant differences were observed for recurrent MI (HR: 0.98, 95% CI 0.87-1.11) or stroke (HR: 1.10, 95% CI 0.93-1.28). Similar target trial emulation design among 18,270 AMI patients with normal liver enzymes at admission (9135 per group) found no significant differences between the two statins in all-cause mortality (HR: 1.09, 95% CI 0.88-1.35), recurrent MI (HR: 1.05, 95% CI 0.90-1.23), or stroke (HR: 1.07, 95% CI 0.90-1.28).</p><p><strong>Conclusions: </strong>Atorvastatin treatment was associated with a higher risk of 1-year all-cause mortality than Rosuvastatin in a target trial emulation study of patients with elevated liver enzymes following AMI.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"796-808"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-hospital admission of heparin in patients with suspected non-ST segment elevation acute coronary syndrome.","authors":"Jonas Sundermeyer, Alina Schock, Caroline Kellner, Paul M Haller, Jonas Lehmacher, Niklas Thießen, Betül Toprak, Lea Scharlemann, Raphael Twerenbold, Nils Arne Sörensen, Peter Clemmensen, Johannes T Neumann","doi":"10.1007/s00392-024-02507-1","DOIUrl":"10.1007/s00392-024-02507-1","url":null,"abstract":"<p><strong>Background: </strong>Evidence supporting pre-hospital heparin administration in patients with suspected non-ST segment elevation acute coronary syndrome (NSTE-ACS) is lacking. We aim to evaluate if pre-hospital heparin administration by emergency medical service improves clinical outcome in patients with suspected NSTE-ACS.</p><p><strong>Methods: </strong>Patients with suspected myocardial infarction (MI) presenting to the emergency department were prospectively enrolled from 2013 to 2021, excluding those with ST segment elevation MI. Patients with and without prehospital heparin administration were compared using propensity score matching. To assess the association between pre-hospital heparin loading, 30-day and 1-year mortality, Kaplan-Meier estimations and Cox regression models were used.</p><p><strong>Results: </strong>Among 1,234 patients, median age was 69 years, 755 (61.2%) were male, 867 (70.5%) with known hypertension, 177 (14.4%) had diabetes, 280 (23.1%) were current smokers, and 444 (36.0%) had a history of CAD. Compared to patients without pre-hospital heparin administration, heparin pre-treated patients were more often active smokers (26.5% vs. 20.8%). After propensity matching, 475 patients with vs. without pre-hospital heparin administration were compared, with no significant difference in 30-day mortality (no-heparin 1.3% vs. heparin 0.4%) and 1-year mortality (no-heparin 7.2% vs. heparin 5.5%, adjusted HR 0.98, CI 0.95-1.01, p = 0.22). Bleeding events occurred at a low frequency (< 2%) and did not differ between groups.</p><p><strong>Conclusions: </strong>In this study, pre-hospital heparin administration was not associated with improved clinical outcome in patients with suspected NSTE-ACS. These findings question pre-hospital heparin therapy in this patient population and might potentially warrant a more restricted utilization pending in-hospital risk assessment.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"738-748"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of greyzone fibrosis compared to troponin T and late gadolinium enhancement with survival and ejection fraction in patients after acute myocardial infarction.","authors":"Ramona Schmitt, Clara Staats, Klaus Kaier, Christoph Ahlgrim, Manuel Hein, Johannes Brado, Philipp Steinhoff, Hannah Billig, Martin Soschynski, Tobias Krauss, Christopher L Schlett, Dirk Westermann, Franz-Josef Neumann, Philipp Ruile, Philipp Breitbart","doi":"10.1007/s00392-024-02536-w","DOIUrl":"10.1007/s00392-024-02536-w","url":null,"abstract":"<p><strong>Aims: </strong>To quantify greyzone fibrosis (GZF) in patients after acute myocardial infarction (MI) and to evaluate its correlation with MI-free survival and improvements in left ventricular ejection fraction (LVEF) compared with the established risk factors high-sensitivity cardiac troponin T (hs-cTnT) and Late Gadolinium Enhancement (LGE).</p><p><strong>Methods and results: </strong>The study involved 176 patients who experienced acute MI and underwent cardiac magnetic resonance (CMR) prior to hospital discharge, followed by a second CMR on average six months later. LGE was quantified in both examinations, a separate analysis of the GZF was conducted only in the follow-up CMR after resolution of the initial infarct edema. LVEF was measured in both CMR. hs-cTnT levels were assessed at hospital admission, as well as 8, 16, 24, 48 and 72 h after coronary intervention. Telephone follow-ups were conducted annually for up to 8 years. LGE measurements showed better correlation with MI-free survival (Harrell's C of 0.711 of LGE mass) compared to GZF (0.579 of GZF mass). Additionally, hs-cTnT outperformed GZF (Harrell's C of 0.645). As an univariable predictor for MI-free survival, only hs-cTnT reached significance (p < 0.05). With regard to improvements in ejection fraction, both hs-cTnT and LGE measurements showed acceptable correlation with improvement in ejection fraction (p < 0.05), while GZF measurements showed no correlation (p > 0.5).</p><p><strong>Conclusions: </strong>In CMR, the assessment of GZF demonstrated inferior p correlation compared to hs-cTnT and LGE in patients after acute MI with respect to the endpoint of MI-free survival. Furthermore, GZF showed no correlation with the improvement of LVEF.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"749-759"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative flow ratio or angiography for the assessment of non-culprit lesions in acute coronary syndromes, a randomized trial.","authors":"Helen Ullrich-Daub, Maximilian Olschewski, Boris Schnorbus, Khelifa-Anis Belhadj, Till Köhler, Markus Vosseler, Thomas Münzel, Tommaso Gori","doi":"10.1007/s00392-024-02484-5","DOIUrl":"10.1007/s00392-024-02484-5","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing percutaneous coronary intervention for acute coronary syndromes often have multivessel disease (MVD). Quantitative flow ratio (QFR) is an angiography-based technology that may help quantify the functional significance of non-culprit lesions, with the advantage that measurements are possible also once the patient is discharged from the catheterization laboratory.</p><p><strong>Aim: </strong>Our two-center, randomized superiority trial aimed to test whether QFR, as compared to angiography, modifies the rate of non-culprit lesion interventions (primary functional endpoint) and improves the outcomes of patients with acute coronary syndromes and MVD (primary clinical endpoint).</p><p><strong>Methods: </strong>In total, 202 consecutive patients (64 [56-71] years of age, 160 men) with STEMI (n = 69 (34%)), NSTEMI (n = 94 (47%)), or unstable angina (n = 39 (19%)) and MVD who had undergone successful treatment of all culprit lesions were randomized 1:1 to angiography- vs. QFR-guided delayed revascularization of 246 non-culprit stenoses (1.2/patient).</p><p><strong>Results: </strong>The proportion of patients assigned to percutaneous intervention was not different between groups (angiography group: 45 (45%) vs. QFR: 56 (55%), P = 0.125; relative risk = 0.80 (0.60-1.06)). At 12 months, a primary clinical endpoint event (composite of death, nonfatal myocardial infarction, revascularization, and significant angina) occurred in 24 patients (angiography-guided) and 23 patients (QFR-guided; P = 0.637, HR = 1.16 [0.63-2.15]). None of its components was different between groups.</p><p><strong>Discussion: </strong>QFR guidance based on analysis of images from the primary intervention was not associated with a difference in the rate of non-culprit lesion staged revascularization nor in the 12-month incidence of clinical events in patients with acute coronary syndromes and multivessel disease.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Registry (NCT04808310).</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"729-737"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 risk factor management and adverse events in patients with early-onset myocardial infarction-a \"real-world\" study.","authors":"Hatim Kerniss, Luis Alberto Mata Marín, Kilian Clemens, Carina Litfin, Annemarie Seidel-Sarpong, Ulrich Hanses, Stephan Rühle, Johannes Schmucker, Rico Osteresch, Andreas Fach, Ingo Eitel, Rainer Hambrecht, Harm Wienbergen","doi":"10.1007/s00392-024-02478-3","DOIUrl":"10.1007/s00392-024-02478-3","url":null,"abstract":"<p><strong>Background: </strong>International guidelines emphasize the importance of preventive efforts after early-onset myocardial infarction (EOMI); however, data on \"real-world\" long-term risk factor management and adverse event rates in this special patient group is scarce.</p><p><strong>Methods: </strong>In this German registry study, 301 patients with MI aged ≤ 45 years were investigated. Risk factor control was assessed at the time of index MI and after 1 year. Major adverse cardiac and cerebrovascular events (MACCE) and its predictors were analyzed during long-term follow-up (median duration 49 months).</p><p><strong>Results: </strong>A majority of patients with EOMI presented with insufficient risk factor control, even during 1-year follow-up. After 1-year 42% of patients were persistent smokers; 74% were physically inactive. The rate of obesity increased significantly from index MI (41%) to 1-year follow-up (46%, p = 0.03) as well as the rate of dysglycemia (index MI: 40%; 1-year follow-up: 51%, p < 0.01) and diabetes mellitus (index MI: 20%; 1-year follow-up: 24%, p < 0.01). 66% of the patients with diabetes mellitus had unsatisfactory HbA1c after 1 year; 69% of the patients did not attain guideline-recommended lipid targets. The rate of MACCE during long-term follow-up was 20% (incidence rate 0.05 per person-year). In a multivariable analysis smoking (HR 2.2, HR 1.3-3.7, p < 0.01) and physical inactivity (HR 2.8, HR 1.2-6.7, p = 0.02) were significant predictors for the occurrence of MACCE.</p><p><strong>Conclusion: </strong>Insufficient long-term risk factor control was common in patients with EOMI and was associated with an elevated rate of MACCE. The study reveals that better strategies for prevention in young patients are crucially needed.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"719-728"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of educational attainment on preventive efforts after myocardial infarction: results of the IPP and NET-IPP trials.","authors":"Harm Wienbergen, Andreas Fach, Ephraim B Winzer, Johannes Schmucker, Ulrich Hanses, Tina Retzlaff, Stephan Rühle, Carina Litfin, Hatim Kerniss, Luis Alberto Mata Marín, Albrecht Elsässer, Stephan Gielen, Ingo Eitel, Axel Linke, Rainer Hambrecht, Rico Osteresch","doi":"10.1007/s00392-023-02285-2","DOIUrl":"10.1007/s00392-023-02285-2","url":null,"abstract":"<p><strong>Aims: </strong>Educational attainment might impact secondary prevention after myocardial infarction (MI). The purpose of the present study was to compare the rate of risk factors and the efficacy of an intensive prevention program (IPP), performed by prevention assistants and supervised by physicians, in patients with MI and different levels of education.</p><p><strong>Methods: </strong>In this post hoc analysis of the multicenter IPP and NET-IPP trials, patients with MI were stratified into two groups according to educational attainment: no \"Abitur\" (no A) vs. \"Abitur\" or university degree (AUD). The groups were compared at the time of index MI and after 12-month IPP vs. usual care.</p><p><strong>Results: </strong>Out of n = 462 patients with MI, 76.0% had no A and 24.0% had AUD. At the time of index, MI rates of obesity (OR 2.4; 95%CI 1.4-4.0), smoking (OR 2.2, 95%CI 1.4-3.6), and physical inactivity (OR 1.6; 95%CI 1.0-2.5) were significantly elevated in patients with no A. At 12 months after index MI, larger improvements of the risk factors smoking and physical inactivity were observed in patients with IPP and no A than in patients with IPP and AUD or with usual care. LDL cholesterol levels were reduced by IPP compared to usual care, with no difference between no A vs. AUD. A matched-pair analysis revealed that high baseline risk was an important reason for the large risk factor reductions in patients with IPP and no A.</p><p><strong>Conclusion: </strong>The study demonstrates that patients with MI and lower educational level have an increased rate of lifestyle-related risk factors and a 12-month IPP, which is primarily performed by non-physician prevention assistants, is effective to improve prevention in this high-risk cohort.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"690-699"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of patients with suspected NSTE-ACS in the observe zone: evaluating GRACE 1.0 score and a biomarker panel for risk stratification and management optimization.","authors":"Mustafa Yildirim, Christoph Reich, Christian Salbach, Moritz Biener, Matthias Mueller-Hennessen, Nils Arne Sörensen, Paul Michael Haller, Stefan Blankenberg, Johannes Tobias Neumann, Raphael Twerenbold, Norbert Frey, Evangelos Giannitsis","doi":"10.1007/s00392-025-02642-3","DOIUrl":"10.1007/s00392-025-02642-3","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend additional diagnostic work-up for patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) triaged in the observe zone using accelerated diagnostic protocols. This study assessed the effectiveness of combining the Global Registry of Acute Coronary Events (GRACE) 1.0 score with additional non-cardio-specific biomarkers for risk stratification in the observe zone.</p><p><strong>Methods: </strong>A total of 6789 patients with suspected NSTE-ACS were enrolled over 24 months, with 961 (21.8%) assigned to the observe zone. A classification and regression tree (CART) analysis dichotomized risk using the GRACE-score and additional biomarkers beyond high-sensitivity cardiac troponin including C-reactive protein < 10 mg/dL, N-terminal pro-B-type natriuretic peptide < 300 ng/L, D-dimers < 5 mg/L, estimated glomerular filtration rate > 30 mL/min/1.73m², Copeptin < 10 pmol/L, and hemoglobin > 10 g/dL. The primary endpoint was 1-year all-cause mortality, validated using the Biomarkers in Acute Cardiac Care (BACC) cohort.</p><p><strong>Results: </strong>A low GRACE 1.0 score < 109 points was found in 37.6% of observe zone patients, showing a negative predictive value of 98.6% and sensitivity of 89.8% for death. Adding biomarker information reduced predicted 1-year-mortality from 1.38% with the GRACE-score alone to 0.46% when none of the biomarkers were above cutoff (prevalent in 22.7%). The proportion of protocol-eligible patients increased from 22.7 to 37.6%, with no events within 30 days. Findings were confirmed in the BACC cohort.</p><p><strong>Conclusion: </strong>A low GRACE 1.0 score combined with ≤ 1 elevated biomarker significantly improves mortality prediction in the observe zone, helping identify low-risk patients for further out-of-hospital diagnostic work-up, potentially decongesting crowded emergency departments. Registration URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov ; Unique identifier: NCT05774431.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"783-795"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual antiplatelet pre-treatment with aspirin and ticagrelor in ACS patients undergoing unplanned aortocoronary bypass surgery.","authors":"Christian Salbach, Mustafa Yildirim, Rebecca Gulba, Barbara Ruth Milles, Moritz Biener, Matthias Mueller-Hennessen, Hauke Hund, Norbert Frey, Evangelos Giannitsis","doi":"10.1007/s00392-025-02629-0","DOIUrl":"10.1007/s00392-025-02629-0","url":null,"abstract":"<p><strong>Background: </strong>Major bleedings following coronary artery bypass grafting (CABG) have significant implications on outcomes in acute coronary syndrome (ACS) patients. Owing fears of fatal bleedings in case of urgent CABG, current guidelines recommend a cessation of P2Y₁₂ receptor antagonists (P2Y₁₂-RA) before cardiac surgery and opt against routine pre-treatment with a P2Y₁₂-RA before coronary angiography (CA). However, sparse information exists outside randomized trials on the frequency of urgent CABG and the consequences of inappropriately long cessation of P2Y₁₂-RA treatment in patients presenting with ACS.</p><p><strong>Methods: </strong>In this observational single-center study, ACS patients presenting to an emergency department requiring a CABG were recruited consecutively during a 2-year enrolment period. Baseline characteristics, CABG-related bleedings and all-cause mortality were collected from electronical medical records and related to the timing of CABG and P2Y₁₂-RA cessation.</p><p><strong>Results: </strong>A total of 1,502 ACS patients were included, herein 102 (6.8%) underwent urgent CABG. The majority (76.5%) received a routine P2Y₁₂-RA pre-treatment predominantly ticagrelor in addition to low-dose aspirin before CA. 31 (30.4%) developed a CABG-related bleeding event. Bleeding probability was highest (HR: 4.77, 95%CI 2.20-10.37, p = 0.0001) when CABG was performed within 24 h after administration of dual anti-platelet therapy (DAPT). Despite high utilization rates of DAPT pre-treatment and high prevalence of CABG-related major bleedings, no fatal bleedings occurred.</p><p><strong>Conclusions: </strong>Need of urgent CABG in ACS is infrequent and does not result in an excess of mortality. However, cessation of ticagrelor for at least 48 h before CABG is recommended to minimize rates of CABG-related bleedings.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"772-782"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 outcome of patients presenting with myocardial injury or myocardial infarction.","authors":"Paul M Haller, Caroline Kellner, Nils A Sörensen, Jonas Lehmacher, Betül Toprak, Alina Schock, Tau S Hartikainen, Raphael Twerenbold, Tanja Zeller, Dirk Westermann, Johannes T Neumann","doi":"10.1007/s00392-023-02334-w","DOIUrl":"10.1007/s00392-023-02334-w","url":null,"abstract":"<p><strong>Aims: </strong>Patients with acute or chronic myocardial injury are frequently identified in the context of suspected myocardial infarction (MI). We aimed to investigate their long-term follow-up.</p><p><strong>Methods and results: </strong>We prospectively enrolled 2714 patients with suspected MI and followed them for all-cause mortality and a composite cardiovascular endpoint (CVE; cardiovascular death, MI, unplanned revascularization) for a median of 5.1 years. Final diagnoses were adjudicated by two cardiologists according to the Fourth Universal Definition of MI, including 143 (5.3%) ST-elevation MI, 236 (8.7%) non-ST-elevation MI (NSTEMI) Type 1 (T1), 128 (4.7%) NSTEMI T2, 86 (3.2%) acute and 677 (24.9%) with chronic myocardial injury, and 1444 (53.2%) with other reasons for chest pain (reference). Crude event rates per 1000 patient-years for all-cause mortality were highest in patients with myocardial injury (81.6 [71.7, 92.3]), and any type of MI (55.9 [46.3, 66.7]), compared to reference (12.2 [9.8, 15.1]). Upon adjustment, all diagnoses were significantly associated with all-cause mortality. Moreover, patients with acute (adj-HR 1.92 [1.08, 3.43]) or chronic (adj-HR 1.59 [1.16, 2.18]) myocardial injury, and patients with NSTEMI T1 (adj-HR 2.62 [1.85, 3.69]) and ST-elevation MI (adj-HR 3.66 [2.41, 5.57]) were at increased risk for cardiovascular events.</p><p><strong>Conclusion: </strong>Patients with myocardial injury are at a similar increased risk for death and cardiovascular events compared to patients with acute MI. Further studies need to determine appropriate management strategies for patients with myocardial injury.</p><p><strong>Registration: </strong>Clinicaltrials.gov (NCT02355457).</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"700-708"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138046343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}