Clinical Research in Cardiology最新文献

{"title":"In-hospital outcomes of catheter ablation in atrial arrhythmias: a nationwide analysis of 2,901 patients with adult congenital heart disease compared to 787,995 without.","authors":"Sebastian Grundmann, Klaus Kaier, Alexander Maier, Jonathan Rilinger, Johannes Steinfurt, Brigitte Stiller, Dirk Westermann, Constantin von Zur Mühlen, Markus Jäckel","doi":"10.1007/s00392-025-02614-7","DOIUrl":"10.1007/s00392-025-02614-7","url":null,"abstract":"<p><strong>Background: </strong>Advances in pediatric cardiology and congenital heart surgery have increased the adult population with congenital heart disease (CHD), now facing long-term complications like atrial arrhythmias. Given the limited data and safety concerns in this unique and vulnerable patient group, this study analyzes in-hospital outcomes of atrial catheter ablation in CHD patients versus non-CHD patients from a German nationwide real-world registry.</p><p><strong>Methods: </strong>Using health records, all atrial catheter ablation procedures in Germany from 2008 to 2021 were analyzed. After adjustment for confounders, safety performance endpoints were compared between patients with and without CHD.</p><p><strong>Results: </strong>From 2008 to 2021, 790,896 patients underwent right or left atrial catheter ablation in Germany. Of these, 1004 patients were classified as simple CHD, 1,054 patients as moderate CHD and 843 patients as complex CHD. Age at time of procedure was lower with increasing complexity of the CHD. Atypical atrial flutter (5.5% vs. 21.8%; p < 0.001) and other atrial tachycardias (21.2% vs. 42.2%; p < 0.001) occurred more often in patients with complex CHD compared to patients without. Combined ablation in both atria was more often performed in complex CHD. Despite higher complexity, in-hospital mortality (< 0.2%) and other investigated complications were rare. After adjustment for baseline characteristics, type of arrhythmia and ablation location, the relative risk for serious adverse events (combination of mortality, stroke, intracerebral bleeding or pericardiocentesis) did not show a significant difference for patients with CHD.</p><p><strong>Conclusion: </strong>Even in patients with CHD, complications are rare and after adjustment, no differences were identified concerning serious adverse events. Therefore, an ablation should not be generally avoided in patients with CHD due to concerns about complications although an individualized evaluation of the anatomy must be taken into account.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"507-515"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482394","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":"First successful epicardial ventricular tachycardia ablation in a patient with substernal implantable cardioverter defibrillator.","authors":"Nándor Szegedi, Ferenc Komlósi, Béla Merkely, László Gellér","doi":"10.1007/s00392-025-02634-3","DOIUrl":"10.1007/s00392-025-02634-3","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"517-519"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613780","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":"Sex-specific outcomes in myocardial infarction: a dual-cohort analysis using clinical and real-world data.","authors":"Johannes Krefting, Christian Graesser, Sophie Novacek, Felix Voll, Aldo Moggio, Nils Krueger, Christian Friess, Marius Schwab, Frank Offenborn, Teresa Trenkwalder, Sebastian Kufner, Erion Xhepa, Michael Joner, Salvatore Cassese, Heribert Schunkert, Gjin Ndrepepa, Adnan Kastrati, Moritz von Scheidt, Thorsten Kessler, Hendrik B Sager","doi":"10.1007/s00392-025-02627-2","DOIUrl":"https://doi.org/10.1007/s00392-025-02627-2","url":null,"abstract":"<p><strong>Background: </strong>Sex-related differences in symptoms, treatment, and outcomes in patients presenting with myocardial infarction have been reported but vary largely between studies. We sought to characterize sex differences in presentation and outcomes of patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).</p><p><strong>Methods and results: </strong>We included 1206 STEMI patients from a clinical cohort and 35,123 STEMI patients obtained from the German health insurance claims. Women, despite being older and thus having a worse cardiovascular risk profile, had greater myocardial salvage and smaller infarct size than men in all patients (median with [interquartile ranges (25th-75th percentiles), IQR]; salvage index: 0.58 [IQR: 0.32-0.91] in females vs. 0.47 [IQR: 0.23-0.77] in males, p < 0.0001; infarct size: 7.0% [IQR: 1.0-22.0%] in females vs. 11.0% [IQR: 3.0-23.0%] of the left ventricle in males, p = 0.002). Same results were shown for propensity score matched pairs (n = 242) (salvage index: 0.60 [IQR: 0.33-0.91] in females vs. 0.44 [IQR: 0.23-0.70] in males, p = 0.0002; infarct size: 7.0% [IQR: 1.0-23.0%] vs. 10% [IQR: 3.0-23.0%] of the left ventricle in males, p = 0.042). Furthermore, women showed a lower risk of 5-year mortality, assessed after propensity score matching, in the health insurance cohort (n = 19,404) (HR = 0.92 [95% CI 0.87-0.97], p = 0.002).</p><p><strong>Conclusions: </strong>In patients with STEMI, women appear to have better myocardial salvage and smaller infarct size after PPCI and a lower 5-year mortality compared with men, suggesting better ischemic tolerance in female patients.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669376","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":"Differences in clinical features and 1-year outcomes of patients with heart failure and reduced, mildly reduced, and preserved ejection fraction in a contemporary cohort: is the clinical profile changing?","authors":"María Anguita-Gámez, Juan L Bonilla-Palomas, Alejandro Recio-Mayoral, Rafael González-Manzanares, Javier Muñiz-García, Nieves Romero-Rodríguez, Francisco J Elola-Somoza, Angel Cequier-Fillat, Luis Rodríguez-Padial, Manuel Anguita-Sánchez","doi":"10.1007/s00392-025-02632-5","DOIUrl":"https://doi.org/10.1007/s00392-025-02632-5","url":null,"abstract":"<p><strong>Aims: </strong>To analyze in a contemporary registry of heart failure (HF) patients followed in specialized HF units in Spain, the differences in clinical features, treatment, and 1-year outcomes in HF with reduced, mildly reduced, and preserved left ventricular ejection fraction.</p><p><strong>Methods and results: </strong>We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1716 patients with HF included between 2019 and 2021 by 45 specialized HF units accredited by the SEC. Treatment and 1-year mortality, HF hospitalizations and decompensations of HF used were compared according to the type of HF. Of the 1,716 patients, 55.5% had HFrEF, 11.9% had HFmrEF, and 32.6% had HFpEF. HFpEF patients were older and had a higher proportion of women, atrial fibrillation, and hypertension. Sacubitril-valsartan and mineral receptor antagonists were used in greater proportion in HFrEF (56.5% and 73%, respectively, p < 0.001), but also in 10.3 and 33% in HFpEF. One-year mortality (17.3 vs 20.9 vs 15.6/100 persons-year; p = 0.321), 1-year HF hospitalizations (34.4 vs 29.5 vs 26.7/100 persons-year; p = 0.330), and 1-year decompensations of HF without hospitalization (13.1 vs 10.4 vs 11.1; p = 0.393) were similar for the 3 types of HF.</p><p><strong>Conclusion: </strong>In our contemporary cohort of real-life HF patients, slight differences were observed in clinical features and treatment between the 3 types of HF, but the prevalence of most of the major comorbidities and 1-year outcomes (mortality, hospitalizations and decompensations of HF) were similar in the 3 groups.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669352","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":"Prospective comparison of temporal changes in myocardial function in women with Takotsubo versus anterior STEMI.","authors":"Sandeep Jha, Angela Poller, Aaron Shekka Espinosa, Linnea Molander, Valentyna Sevastianova, Rickard Zeijlon, Koen Simons, Emanuele Bobbio, Carlo Pirazzi, Andreas Martinsson, Tomas Mellberg, Thorsteinn Gudmundsson, Petronella Torild, Joakim Sundstrom, Erik Axel Andersson, Sigurdur Thorleifsson, Sabin Salahuddin, Ahmed Elmahdy, Tetiana Pylova, Araz Rawshani, Oskar Angeras, Truls Ramunddal, Kristofer Skoglund, Elmir Omerovic, Bjorn Redfors","doi":"10.1007/s00392-025-02633-4","DOIUrl":"https://doi.org/10.1007/s00392-025-02633-4","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo syndrome (TS) and STEMI with timely reperfusion are both characterized by reversible acute myocardial dysfunction, often referred to as myocardial stunning. The natural course of cardiac functional recovery is incompletely understood in TS and STEMI. The aim of this study was to prospectively compare changes in cardiac function over the acute and subacute phases in women with TS versus anterior STEMI.</p><p><strong>Methods: </strong>The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study prospectively enrolled 61 women with TS and 41 women with STEMI. Echocardiography and blood sampling was performed within 4 h of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was the proportion of reversible left ventricular akinesia (defined as extent of akinesia at baseline versus at 30 days) that resolved by 72 h. Secondary outcomes included LVEF, GLS, and TAPSE. Mixed effects linear regression or mixed effects tobit models with random intercepts were used to model echocardiographic parameters over time.</p><p><strong>Results: </strong>At 72 h 40.4% [95% CI 30.1%, 50.1%] of the reversible akinesia had resolved in women with TS, versus 54.7% [95% CI 38.3%, 72.0%] for STEMI (difference 14.3% [95% CI - 4.6%, 34.3%]). Time-course of recovery of LVEF and GLS was also similar in TS and STEMI. TAPSE was reduced in TS but normal in STEMI; and recovered in a similar timeframe as the left ventricular indices. In both TS and STEMI, considerable recovery of cardiac function occurred after 7 days.</p><p><strong>Conclusions: </strong>The time course of recovery of cardiac function is similar in TS and STEMI.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID NCT04448639, https://clinicaltrials.gov/study/NCT04448639 .</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669371","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":"Antithrombotic strategy following valve-in-valve transcatheter aortic valve replacement. A German Statutory Health Claims data analysis.","authors":"Sebastian Heyne, Christopher Hohmann, Sascha Macherey-Meyer, Max M Meertens, Elmar Kuhn, Ursula Marschall, Hendrik Wienemann, Victor Mauri, Matti Adam, Stephan Baldus, Samuel Lee","doi":"10.1007/s00392-025-02635-2","DOIUrl":"https://doi.org/10.1007/s00392-025-02635-2","url":null,"abstract":"<p><strong>Aims: </strong>Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) procedures are increasingly used. Specific recommendations on antithrombotic strategies following ViV-TAVR are lacking. We aimed to assess the efficacy of different antithrombotic strategies following ViV-TAVR.</p><p><strong>Methods and results: </strong>We performed a retrospective analysis of German Statutory Health Claims data following ViV-TAVR stratified by antithrombotic strategies according to prescription within 90 days. Antithrombotic regimens included antiplatelet therapy (APT), direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). The composite endpoint was all-cause mortality, stroke and/or systemic embolism (SSE) and mechanical complication of heart valve prosthesis at 12 months. Cox proportional hazard regression models were used to compare outcomes. In total, 908 patients between 2005 and 2022 were identified. Of these, 286 received DOACs, 99 received VKAs, 351 received APT exclusively and 172 had no prescription. The incidence of the composite endpoint was 20.8% in the APT group, 20.3% in the DOAC group and 25.3% in the VKA group which was not statistically significantly different. The rate of SSE in the acetylsalicylic acid (ASA) mono group was higher compared to the dual antiplatelet therapy (DAPT) group (27.3% vs. 12.4%, univariable HR 0.42, 95% CI [0.19, 0.95], p = 0.03).</p><p><strong>Conclusion: </strong>In this analysis of German Health Claims data, DOACs seemed to be a safe alternative to VKAs and APT. ASA monotherapy was associated with higher rates of SSE compared to DAPT. Given the high risk of bias of this retrospective analysis and the growing use of valve-in-valve procedures, randomized controlled trials are needed to confirm these findings.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669349","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":"Clinical outcomes according to the average daily dose of sacubitril/valsartan: a nationwide longitudinal cohort study.","authors":"Jaehyun Lim, Hyun-Jung Lee, Soongu Kwak, Bongseong Kim, Kyung-Do Han, Heesun Lee, Jun-Bean Park, Yong-Jin Kim, Hyung-Kwan Kim","doi":"10.1007/s00392-025-02602-x","DOIUrl":"https://doi.org/10.1007/s00392-025-02602-x","url":null,"abstract":"<p><strong>Aims: </strong>A minority of patients with heart failure (HF) are prescribed the maximal dose of the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan. We investigated the effectiveness of submaximal doses of sacubitril/valsartan in a real-world cohort.</p><p><strong>Methods and results: </strong>Patients with HF with reduced ejection fraction prescribed sacubitril/valsartan for ≥ 180 days between 2016 and 2020 were included from a nationwide database, and categorized into tertiles based on the average daily sacubitril/valsartan dosage. Baseline characteristics were balanced using inverse probability of treatment weighting with propensity scores. The primary outcome was a composite of HF hospitalization and all-cause mortality. The study included 3,953 patients (age 62.6 ± 12.4 years, 73.0% men). Patients on lower sacubitril/valsartan doses were older, more likely to be women, and had more comorbidities, with lower blood pressure, reduced kidney function, and lower body mass index; however, baseline characteristics were well balanced across the groups after weighting. During a mean follow-up of 2.0 ± 0.7 years, there were 808 events (20.4%). The risk of the primary outcome in the middle (HR 0.93, 95% CI 0.78-1.10) and the highest dosage tertiles (HR 0.88, 95% CI 0.74-1.06) did not significantly differ compared with the lowest dosage tertile (p-value = 0.384). Regarding individual outcomes, there was no significant difference in HF hospitalization; however, there was a trend toward lower mortality with higher sacubitril/valsartan dose (p-value = 0.047).</p><p><strong>Conclusions: </strong>No significant difference was observed in the composite risk of HF hospitalization and all-cause mortality across different sacubitril/valsartan dosage groups. This suggests that the benefits of sacubitril/valsartan treatment may not necessarily be dose-dependent.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656025","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":"Prognostic effect of the combined use of thiazides and loop diuretics at discharge following a hospitalization for acute heart failure.","authors":"Gema Miñana, Joan Carles Trullàs, Rafael de la Espriella, Raquel Núñez-Aragon, Andrea Gasull, Juan-Bosco López-Saez, Jorge Montiel, Miguel Lorenzo-Hernández, Agustín Fernández-Cisnal, Ernesto Valero, Gonzalo Núñez, Vicent Bodí, Òscar Miró, Juan Sanchis, Antoni Bayés-Genis, Julio Núñez","doi":"10.1007/s00392-025-02631-6","DOIUrl":"https://doi.org/10.1007/s00392-025-02631-6","url":null,"abstract":"<p><strong>Aims: </strong>There is limited information regarding the clinical impact of the concurrent use of thiazides and loop diuretics (LD) after an episode of acute heart failure (AHF) hospitalization. We aimed to evaluate the impact of thiazide prescription at discharge on top of LD on the short-term risk of AHF readmission.</p><p><strong>Methods: </strong>We included 3384 consecutive patients discharged from January 2008 to September 2021 after an admission for AHF in a single teaching center. The association between thiazides on discharge across the intensity of LD treatment and 30-day AHF readmission was explored by Cox regression analysis. A validation cohort of 622 patients was also examined.</p><p><strong>Results: </strong>The mean age of the patients was 73.8 ± 11.2 years, 1672 (47.5%) were women, and 1733 (51.2%) patients showed left ventricular ejection fraction > 50%. The median (IQR) NT-proBNP was 3409 (1829-6963) pg/mL. At discharge, 754 (22.3%) patients received high LD doses (> 80 mg/day) and 187 (5.5%) thiazides. At 30 days, we registered 76 (2.2%) deaths and 449 (13.3%) AHF readmissions. Thiazides at discharge were not associated with the risk of 30-day AHF readmission (HR = 0.92). However, this association was differentially influenced by the intensity of LD doses (p-value for interaction = 0.030), with a lower AHF-readmission risk in those with LD dose > 80 mg/day (p = 0.038), and a neutral association in those receiving low LD dose (≤ 80 mg/day) (p = 0.541).</p><p><strong>Conclusions: </strong>In patients discharged after an episode of AHF, thiazide prescription was associated with a lower risk of 30-day AHF readmission when they were prescribed in patients receiving high LD doses.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656029","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":"Statins for primary prevention of cardiovascular disease in Germany: benefits and costs.","authors":"Alexander Dressel, Felix Fath, Bernhard K Krämer, Gerald Klose, Winfried März","doi":"10.1007/s00392-025-02608-5","DOIUrl":"https://doi.org/10.1007/s00392-025-02608-5","url":null,"abstract":"<p><strong>Background: </strong>The reduction of LDL cholesterol lowers the risk of coronary and cerebrovascular events in individuals without manifest cardiovascular diseases. In Germany, statins at the expense of statutory health insurance had only been permitted for patients with atherosclerosis-related diseases or those at high cardiovascular risk (over 20 percent event probability within the next 10 years, calculated using one of the \"available risk calculators\"). However, international guidelines recommend lower risk thresholds for the use of statins.</p><p><strong>Methods: </strong>The health and economic impacts of different risk thresholds for statin use in primary prevention within the German population are estimated for thresholds of 7.5, 10, and 15 percent over 10 years, based on the US Pooled Cohort Equation (PCE) which is valid for Germany, using Markov models.</p><p><strong>Findings: </strong>Cost-effectiveness increases with a rising risk threshold, while individual benefit decreases with age at the start of treatment. The use of statins at a risk of 7.5 percent or more is cost-effective at any age (cost per QALY between 410 and 2100 Euros). In none of the examined scenarios does the proportion of the population qualifying for statin therapy exceed 25 percent.</p><p><strong>Interpretation: </strong>Lowering the threshold for statin therapy to a risk of 7.5 percent of either non-fatal myocardial infarction, coronary heart disease death, non-fatal or fatal stroke would align statin prescription in Germany with international standards. There is no urgent rationale for applying age-stratified risk thresholds.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647559","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":"Absence of chest discomfort in type 1 NSTEMI patients: predictors and impact on outcome.","authors":"J Michael Altstidl, Merve Günes-Altan, Maximilian Moshage, Florian Weidinger, Lennart Lorenz, Dominik Weimann, Christina Chapuzot, Monique Tröbs, Mohamed Marwan, Stephan Achenbach, Luise Gaede","doi":"10.1007/s00392-025-02628-1","DOIUrl":"https://doi.org/10.1007/s00392-025-02628-1","url":null,"abstract":"<p><strong>Background: </strong>The absence of chest discomfort has been hypothesized to delay treatment and consequently result in worse outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI).</p><p><strong>Methods: </strong>In 888 consecutive patients with type 1 NSTEMI, symptoms were systematically classified as chest discomfort defined as chest pain or pressure, dyspnea or other symptoms, e.g. epigastric pain. Patient characteristics predictive for the absence of chest discomfort and the impact of the symptom type on adverse in-hospital events (all-cause mortality, cardiogenic shock, and mechanical ventilation) were analyzed.</p><p><strong>Results: </strong>Chest discomfort was reported in 81.0%, dyspnea without chest discomfort in 12.2%, and only other symptoms in the remaining 6.9% of patients. In a multivariable regression analysis, female sex (p = 0.035), diabetes mellitus (p = 0.003), the absence of any family history of coronary artery disease (CAD) (p = 0.002), anemia (p < 0.001), and atrial fibrillation or flutter at presentation (p = 0.017) were independent predictors for the absence of chest discomfort. The absence of chest discomfort was associated with a higher rate of in-hospital adverse events (10.6% for chest discomfort vs. 29.6% for dyspnea and 27.9% for other symptoms, p < 0.001), which appeared partially mediated (p = 0.044) by longer times from diagnosis to invasive management (p < 0.001).</p><p><strong>Conclusions: </strong>In type 1 NSTEMI, the absence of chest discomfort is associated with a higher rate of adverse in-hospital events. Women, diabetics, patients without a family history of CAD, patients with anemia, and patients with atrial fibrillation are more likely to present without chest discomfort and special attention may be required to avoid delayed invasive management in these patients.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623840","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}