Clinical Research in Cardiology最新文献

{"title":"Optimal revascularization strategy in patients with acute coronary syndrome and multivessel disease: insights from a network meta-analysis.","authors":"Andrea Milzi, Stefano Benenati, Antonio Landi, Florian Kahles, Italo Porto, Marco Valgimigli","doi":"10.1007/s00392-025-02693-6","DOIUrl":"https://doi.org/10.1007/s00392-025-02693-6","url":null,"abstract":"<p><p>Coronary multivessel disease (MVD) affects approximately 50% of the patients presenting with acute coronary syndrome (ACS). The optimal revascularization strategy after culprit lesion treatment, including the optimal method to select non-culprit lesions amenable to revascularization, remains unsettled. This study sought to compare culprit-only revascularization, angiography-guided complete revascularization, and physiology-guided complete revascularization in multivessel disease (MVD) patients with acute coronary syndrome (ACS). We searched PUBMED and Web of Science for randomized controlled trials investigating outcomes following culprit-only revascularization, angiography-guided complete revascularization or physiology-guided complete revascularization in patients with ACS and MVD. We identified 14 randomized studies and 11,871 participants with ACS and MVD, of whom 5090 underwent culprit-only intervention, 3641 angiography-guided complete revascularization, 3140 physiology-guided complete revascularization). Major adverse cardiac events (MACE) were lower in both angiography- (IRR 0.60, 95%-CI 0.46-0.79) or physiology-guided (IRR 0.65, 95%-CI 0.50-0.85) complete revascularization compared with culprit-only revascularization. P-score for treatment ranking was higher for angiography- (0.834) than physiology-guidance (0.666). The estimated effects for all-cause and cardiovascular death vs. culprit-only revascularization were 0.89 (95%-CI 0.61-1.30) and 0.82 (95%-CI 0.48-1.40) for angiography-guidance, and 0.78 (95%-CI 0.55-1.11) and 0.64 (95%-CI 0.40-1.01) for physiology-guidance, respectively. For both all-cause death and cardiovascular death, the highest benefit was estimated for physiology-guidance (P-scores respectively 0.821 and 0.870). In patients with ACS and MVD, both angiography- and physiology-guided complete revascularization are superior to culprit-only revascularization with respect to MACE reduction. Angiography-guidance and physiology-guidance were comparable for future events prevention.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526717","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":"Target doses of guideline-directed medical therapeutic agents predicts response to cardiac resynchronization therapy.","authors":"Tyler J Kingma, Hossam Albeyoumi, Madhumita Kolluri, Avin Sapowadia, Aryan Mehta, Obada Kholoki, Siddhant Passey, Dorothy Wakefield, Saima Husain","doi":"10.1007/s00392-025-02708-2","DOIUrl":"https://doi.org/10.1007/s00392-025-02708-2","url":null,"abstract":"<p><strong>Background: </strong>The mainstay of therapy in patients with heart failure with reduced ejection fraction (HFrEF) has long been guideline-directed medical therapy (GDMT). This is further complicated by those who have concomitant ventricular dyssynchrony due to conduction abnormalities requiring implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT). The aim in our study was to investigate the role of GDMT in predicting response to CRT.</p><p><strong>Methods: </strong>We performed a retrospective chart review of 181 patients at St. Francis Hospital of Trinity Health of New England and UConn John Dempsey Hospital with HFrEF diagnosis who underwent CRT between 01/01/2014 to 01/01/2024. Specifically, individual medications were evaluated as either meeting the target dose or not of GDMT prior to CRT. Then, the effect of achieving target doses was then compared in patients deemed CRT 'responders' and 'non-responders'.</p><p><strong>Results: </strong>Patients receiving a higher number of optimally dosed GDMT showed a significant trend (p = 0.0277) toward responding to CRT. There was no significant difference between 1 and 0 therapies (OR 1.487; 95% CI, 0.689-3.209) and between 1 and 2-4 (OR 0.427; 95% CI, 0.123-1.487). However, patients receiving 2-4 optimally dosed GDMT were 3.48 times (95% CI, 1.050-11.529) more likely to be a responder when compared to those on 0 optimally dosed therapies.</p><p><strong>Conclusions: </strong>There is a statistically significant trend toward responding to CRT when patients are on a higher number of optimally dosed GDMT, especially with > 2 therapies. Based on this data, patients should be optimized with as many optimally dosed medications as tolerated for improved outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526719","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":"Absorb® bioresorbable scaffold in \"established\" versus \"off-label\" coronary lesions: 5-year data from the GABI-R® registry.","authors":"Aydin Huseynov, Michael Behnes, Holger Nef, Thomas Riemer, Steffen Schneider, Thomas Pfannebecker, Stephan Achenbach, Julinda Mehilli, Thomas Münzel, Tommaso Gori, Jochen Wöhrle, Ralf Zahn, Johannes Kastner, Axel Schmermund, Gert Richardt, Christian W Hamm, Ibrahim Akin","doi":"10.1007/s00392-025-02707-3","DOIUrl":"https://doi.org/10.1007/s00392-025-02707-3","url":null,"abstract":"<p><strong>Background: </strong>The potential benefits of bioabsorbable stents can be better assessed over the long term. The implantation of bioresorbable scaffold (BRS) in situations with off-label indications provides real-world insights into how clinical events differ in contrast to standard proved indications.</p><p><strong>Objectives: </strong>The study provides long-term follow-up data about the use of bioresorbable scaffold (BRS) for off-label compared with approved indications.</p><p><strong>Methods: </strong>Five-year outcome data of an everolimus-eluting, poly-L-lactic acid-based bioresorbable scaffold system (ABSORB, Abbott Vascular, Santa Clara, CA, USA) were evaluated in the prospective, non-interventional, multicenter real-world German-Austrian ABSORB-RegIstRy (GABI-R). The patients were enrolled from a total of 93 centers. Data processing and prospective follow-up were conducted centrally and independently of industry.</p><p><strong>Results: </strong>A total of 3082 patients were enrolled between 2013 and 2016. Most patients were included into the off-label group (2317, 75.2%). ST-elevation myocardial infarction (STEMI) was significantly more common in the off-label group (35.9% vs. 27.8%, p = 0.003), and the extent of coronary heart disease was higher in the off-label group (coronary 3 vessel disease 28.4% vs. 22.4%, p < 0.001). Patients with off-label indications had statistically significant higher rates of stent thrombosis after 30 days (1.08% vs. 0.26%, p = 0.04) and target vessel failure (TVF) after 6 months (4.62% vs. 2.61%, p = 0.02).</p><p><strong>Conclusions: </strong>The off-label use of BRS is associated with a higher rate of stent thrombosis in the short term and in the long term with higher MACE events considering more complex lesions and a higher morbidity. In the long term, there are no differences regarding stent thrombosis.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526715","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":"Right ventricular function in pulmonary hypertension and obesity: a cross-sectional cohort study with survival follow-up.","authors":"B Egenlauf, M Braun, V Schiffer, A M Marra, P Xanthouli, S Harutyunova, C A Eichstaedt, C Erbel, R Schell, F Linden, E Grünig, Nicola Benjamin","doi":"10.1007/s00392-025-02682-9","DOIUrl":"https://doi.org/10.1007/s00392-025-02682-9","url":null,"abstract":"<p><strong>Background: </strong>Obesity or underweight can complicate and aggravate symptoms and progression of right heart failure in patients with pulmonary arterial hypertension (PAH). This study investigates the influence of different body mass index (BMI) categories on right heart function and outcome in PAH patients.</p><p><strong>Methods: </strong>In this cross-sectional study with survival follow-up (mean follow-up 3.1 ± 2.6 years, median 2.7 years), clinical measures such as WHO-functional class and invasively measured hemodynamic parameters at initial diagnosis of PAH were compared between different BMI groups.</p><p><strong>Results: </strong>Out of 2055 data sets, 755 patients with PAH (62.5% female) were eligible for the study (65 ± 15 years, 44.9% idiopathic PAH, 64.8% WHO functional class III or IV). Out of them 15 patients (1.99%) were underweight (BMI < 18 kg/m²), 248 (32.85%) patients had a normal weight (BMI 18.5-25 kg/m²), 256 (33.91%) were overweight (BMI > 25 to 30 kg/m²) and 236 patients (31.26%) were classified as obese (BMI > 30 kg/m²). Worst survival was denoted for patients with BMI < 18.5 kg/m², best survival for BMI > 25 to 30 kg/m². Cardiac output (CO) significantly differed between BMI groups (p < 0.0001, R = 0.268) and sex. In multivariable age-adjusted survival analysis, BMI-status, sex and right ventricular function were identified as independent predictors of survival.</p><p><strong>Conclusions: </strong>This is the first study to assess RV function with regard to BMI status and survival in PAH. The study underlines the importance of the parameter body weight in the clinical management of PAH patients. It provides important insights in the relations of BMI and CO and documented significant gender differences.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474116","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":"Implementation of transcutaneous ultrasound-guided axillary vein access for implantations, revisions and upgrades of cardiac implantable electronic devices in a large tertiary care center.","authors":"Julius Nikorowitsch, Tahsin Üctas, Katrin Borof, Andreas Metzner, Jan-Per Wenzel, Simon Julius Winkelmann, Simon Pecha, Yalin Yildirim, Hermann Reichenspurner, Paulus Kirchhof, Tobias Tönnis, Nina Becher","doi":"10.1007/s00392-025-02692-7","DOIUrl":"https://doi.org/10.1007/s00392-025-02692-7","url":null,"abstract":"<p><strong>Background: </strong>Central venous access for cardiac implantable electronic device (CIED) implantations is conventionally acquired via the cephalic or subclavian vein. Controlled data suggest that axillary vein access may reduce complications.</p><p><strong>Objectives: </strong>We, therefore, shifted institutional practice from subclavian vein access to ultrasound (US)-guided axillary vein access for new implantations and revisions or upgrades and report on implant success rates, learning curves and periprocedural complications.</p><p><strong>Methods: </strong>Between January 2021 and August 2023, all patients undergoing CIED implantations, revisions or upgrades were analyzed. US-guided axillary access was introduced starting with one operator and spreading to most operators and trainees thereafter. Periprocedural outcomes and complications (pocket hematoma, hemothorax, and pneumothorax) of transcutaneous US-guided axillary vein access were compared to the subclavian vein access.</p><p><strong>Results: </strong>In this study, 986 patients (median age: 75 years, interquartile range (IQR) 64-82 years, 35% women) with 87% new implantations and 13% revisions or upgrades were included. Transcutaneous US-guided axillary access was successful in 535/578 patients (93%), subclavian vein access in 400/408 patients (98%) (p < 0.001). For device upgrades or revisions specifically, axillary access was successful in 69/79 patients (87%), versus 45/47 patients (96%) with subclavian access (p = 0.208). The learning curve for axillary access was steep with success rates of 93 after 30 cases per operator. Complications occurred in 2/578 patients (0.3%) undergoing axillary vein access versus 17/408 patients (4.2%) (p < 0.001) undergoing subclavian vein access.</p><p><strong>Conclusion: </strong>The implementation of transcutaneous US-guided axillary vein access for implantation, revisions and upgrades of cardiac electronic devices is feasible in a large tertiary care center. The periprocedural complications are rare.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474114","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":"Comparison of left atrial appendage occlusion with medical treatment for non-valvular atrial fibrillation: systematic review, network and reconstructed individual patient data meta-analysis.","authors":"Tsahi T Lerman, Roy Hershenson, Noam Greenberg, Mark Kheifets, Yeela Talmor-Barkan, Pablo Codner, Leor Perl, Guy Witberg, Aviad Rotholz, Shelly Vons, Katia Orvin, Alon Eisen, David Belkin, Boris Fishman, Gregory Golovchiner, Ran Kornowski, Amos Levi","doi":"10.1007/s00392-025-02697-2","DOIUrl":"https://doi.org/10.1007/s00392-025-02697-2","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous left atrial appendage occlusion (LAAO) is a non-pharmacological strategy to prevent stroke and systemic emboli in patients with non-valvular atrial fibrillation (AF). However, data regarding its safety and efficacy profile compared to different oral anti-coagulant regimens remain limited.</p><p><strong>Methods: </strong>A network meta-analysis compared LAAO, warfarin, and NOACs (standard dose [SD] and low-dose [LD]). Outcomes included all-cause mortality, stroke or systemic embolism, and bleeding risk. Bayesian models with surface under the cumulative ranking curve (SUCRA) and reconstructed individual patient data (IPD) were utilized.</p><p><strong>Results: </strong>Twelve studies, including eight randomized controlled trials, were analyzed (13,049 patients with LD NOAC, 29,513 with SD NOAC, 29,611 with warfarin, and 2811 with LAAO). Warfarin was inferior for all-cause mortality compared to LAAO (OR 1.44 [95% CrI; 1.07-1.89]), LD NOAC (OR 1.13 [95% CrI; 1.01-1.26]), and SD NOAC (OR 1.11 [95% CrI; 1.02-1.20]). SUCRA analysis ranked SD NOAC as the most effective for stroke or systemic emboli prevention, LD NOAC as the most effective in preventing major bleeding and LAAO in preventing hemorrhagic stroke.</p><p><strong>Conclusions: </strong>SD NOACs were the most effective for preventing stroke or systemic embolism, while LD NOACs were the safest in terms of major bleeding. LAAO was comparable to NOACs and superior to warfarin in both safety and efficacy. Further studies are needed to clarify LAAO's role in the management of atrial fibrillation.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474099","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":"Fighting time: the critical importance of pre-TAVR mortality risk prediction.","authors":"Jasmin Shamekhi, Marius Ebert, Angelina Lorek, Irina Eckardt, Baravan Al-Kassou, Mustafa Mousa Basha, Marcel Weber, Miriam Silaschi, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer","doi":"10.1007/s00392-025-02698-1","DOIUrl":"https://doi.org/10.1007/s00392-025-02698-1","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not account for individual patient risk profiles due to limited data on mortality rates during the waiting period and a lack of viable risk assessment. Consequently, non-prioritized wait times may be unacceptably long for high-risk patient populations.</p><p><strong>Objective: </strong>This study aimed to evaluate the mortality rate of patients with symptomatic severe AS awaiting TAVR and identify pragmatic clinical risk predictors during this period.</p><p><strong>Methods: </strong>Between January 2019 and December 2023, 2,454 patients with symptomatic severe AS, were scheduled for TAVR after an interdisciplinary Heart Team discussion at the Heart Center Bonn. Mortality during the waiting period was assessed, and the characteristics of survivors (patients who underwent TAVR) were compared to non-survivors (patients who died before the procedure).</p><p><strong>Results: </strong>The median waiting time for TAVR was 41 days. A total of 105 (4.3%) patients died during the waiting period, with a median time to death of 29 days. By comparison, 30 day post-TAVR mortality, including the intervention, was 1.7%. Multivariate regression analysis identified independent predictors of pre-TAVR mortality including reduced left ventricular ejection fraction, decreased estimated glomerular filtration rate, mitral regurgitation, tricuspid regurgitation, and advanced heart failure symptoms. An IMPACT score, incorporating these parameters, strongly predicted outcome with a hazard ratio for mortality of 2.1 greatly outperforming both EuroSCORE II and STS-PROM. The IMPACT score of ≥ 5 identified high-risk patients with a pre-TAVR mortality rate of 12.6%.</p><p><strong>Conclusion: </strong>The mortality rate for patients with symptomatic severe AS awaiting TAVR is unacceptably high. Utilizing the IMPACT score could enable precise risk stratification, identifying patients who require urgent or prioritized intervention to improve outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474113","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":"CT-based evaluation of patient-prosthesis mismatch after transcatheter aortic valve implantation and its influence on outcome.","authors":"Ramona Schmitt, Nils Ressler, Klaus Kaier, Johannes Brado, Manuel Hein, Martin Soschynski, Dirk Westermann, Franz-Josef Neumann, Philipp Breitbart, Philipp Ruile","doi":"10.1007/s00392-025-02701-9","DOIUrl":"https://doi.org/10.1007/s00392-025-02701-9","url":null,"abstract":"<p><strong>Background: </strong>Patient-prosthesis mismatch (PPM) after trans-catheter aortic valve implantation (TAVI) is a risk factor for heart failure and mortality. Assessment of PPM using transthoracic echocardiography (TTE) and presence of hypo-attenuated leaflet thickening (HALT) may lead to overestimation. Our study aimed to assess the incidence of PPM using TTE and CTA after exclusion of patients with HALT and to evaluate predictors analyzing stent geometry.</p><p><strong>Methods: </strong>444 patients were analyzed. PPM was calculated using the continuity equation from TTE (TTE-PPM) and CTA (CT-PPM). Regression analyses were conducted for the endpoint effective orifice area (EOA) as surrogate for PPM.</p><p><strong>Results: </strong>Severe PPM was detected in 4.5% using TTE-PPM and in 0.5% using CT-PPM. Body mass index (BMI) was identified as a predictor for a smaller EOA in each model (p < 0.001). Using TTE-PPM and CT-PPM, a smaller valve diameter was associated with a smaller effective orifice area (EOA) (p < 0.001). Presence of a balloon-expanding valve was associated with a smaller EOA using CT-PPM (p = 0.033). Stent geometry did not influence the EOA (p > 0.05 each model). EOA did not influence overall survival (p > 0.05 each model).</p><p><strong>Conclusions: </strong>The incidence of severe PPM was very low and only predicted by BMI in each assessment model. Stent geometry did not influence the incidence of PPM. Overall survival was not influenced by a smaller EOA.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474100","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":"Phenomapping of subgroups in high-Lp(a) patients: a data-driven cluster analysis in RED-CARPET study.","authors":"Shaozhao Zhang, Xiaoyu Lin, Rongjian Zhan, Huimin Zhou, Yuhui Lai, Mengting Huang, Bingzhen Li, Xinxue Liao, Xiaodong Zhuang","doi":"10.1007/s00392-025-02669-6","DOIUrl":"https://doi.org/10.1007/s00392-025-02669-6","url":null,"abstract":"<p><strong>Background: </strong>The association between high levels of lipoprotein (a) [Lp(a)] and cardiovascular disease (CVD) is influenced by clinical characteristics. We aimed to explore the heterogeneity in high Lp(a) population with different clinical phenotypes and their relationship with atherosclerosis cardiovascular disease (ASCVD) risk.</p><p><strong>Methods and results: </strong>We included 11,629 participants with Lp(a) measurement in RED-CARPET Study (ChiCTR2000039901) from the First Affiliated Hospital of Sun Yat-Sen University. The primary outcome was the occurrence of ASCVD events. The k-means clustering method was performed for baseline variables in participants with high Lp(a) levels (Lp(a) ≥ 50 mg/dL). Multivariate logistic regression model was used to assess the association between high Lp(a) level and ASCVD across clusters, with the low-Lp(a) group (Lp(a) < 50 mg/dL) serving as reference. Propensity score matching (PSM) was used to validate thefindings. High-Lp(a) group was categorized into four clusters: cluster 1 (dyslipidemia); cluster 2 (aged females); cluster 3 (males with an unhealthy lifestyle) and cluster 4 (anemia, renal insufficiency and hypercoagulability). Patients in different clusters exhibited differences in ASCVD risk. Patients with high-Lp(a) had significantly highest risk for ASCVD in cluster 3 (OR 2.12, 95% CI 1.62-2.76, p < 0.001) after adjusting for traditional risk factors. However, no significant association was observed in cluster 4 (OR 0.82, 95% CI 0.58-1.16, p = 0.233). These findings remained consistent after PSM.</p><p><strong>Conclusions: </strong>Using a data-driven approach, high-Lp(a) patients can be stratified into four phenotypically distinct subgroups with different ASCVD risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474115","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":"Drug-coated balloon vs drug-eluting stent in de novo coronary lesions: a propensity score matched cohort study.","authors":"Ulrike Baumer, Eva Steinacher, Andreas Hammer, Niema Kazem, Felix Hofer, Bernhard Frey, Irene Lang, Christian Hengstenberg, Rayyan Hemetsberger, Patrick Sulzgruber, Alexander Niessner, Lorenz Koller","doi":"10.1007/s00392-025-02700-w","DOIUrl":"https://doi.org/10.1007/s00392-025-02700-w","url":null,"abstract":"<p><strong>Background: </strong>The use of drug-coated balloons (DCB) in percutaneous coronary interventions (PCI) is increasing due to potential benefits mainly by avoiding foreign material although a widespread application area beyond in-stent restenosis lacks robust clinical data to date. As such, we aimed to assess the safety and efficacy of DCBs in treating de novo lesions.</p><p><strong>Methods: </strong>For this analysis, we included all patients treated with DCB in a de novo lesions from 2010 to 2019 at our institution. We performed a 1:1 propensity score matching to pair each DCB intervention with a comparable DES intervention. Follow-up continued until 09/2022 to assess clinical outcomes.</p><p><strong>Results: </strong>A total of 303 patients with de novo lesion were matched to 303 patients with comparable baseline characteristics. The median follow-up time was 5.7 years (IQR 2.7-9.3). There were no significant differences in cardiovascular (CV) mortality (HR 1.01 [95% CI 0.87-1.19], p value 0.874), all-cause mortality (HR 1.05 [95% CI 0.91-1.22], p value 0.491), MACE (HR 1.10 [95% CI 0.96-1.26], p value 0.170), acute myocardial infarction (HR 1.08 [95% CI 0.90-1.19], p value 0.308), or any revascularization (HR 1.03 [95% CI 0.90-1.19], p value 0.671) between both groups. However, we observed a trend toward lower rates of target lesion revascularization in patients with small vessel disease (HR 0.84 [95% CI 0.68-1.02], p value 0.072), and in side branch lesions (HR 0.79 [95% CI 0.58-1.04], p value 0.096).</p><p><strong>Conclusion: </strong>DCBs demonstrated long-term safety and efficacy in de novo lesions, with promising trends in reducing target lesion revascularization in small vessel disease and side branches.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474111","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}