Clinical Research in Cardiology最新文献

{"title":"Clinical performance of the next generation Elecsys Troponin T high-sensitivity Gen 6 assay in acute coronary syndrome (PERFORM-TSIX): study design.","authors":"Lori B Daniels, Evangelos Giannitsis, Christian Mueller, Steven J R Meex, David Buehlmann, Dunja Kurtoic, Garnet Bendig, Mette Cole, Richard Body, Robert H Christenson, Christa Cobbaert, Christopher R deFilippi, Kai M Eggers, Kenji Inoue, Allan S Jaffe, Cian P McCarthy, James McCord, Johannes T Neumann, Torbjørn Omland, Cynthia Papendick, Yader Sandoval, Jack Wei Chieh Tan, Martin P Than, Raphael Twerenbold, Nicholas L Mills, W Frank Peacock","doi":"10.1007/s00392-025-02842-x","DOIUrl":"10.1007/s00392-025-02842-x","url":null,"abstract":"<p><strong>Background: </strong>High-sensitivity cardiac troponin (hs-cTn) assays are the gold standard for the early diagnosis and risk stratification of acute myocardial infarction (AMI). PERFORM-TSIX (clinicaltrials.gov identifier: NCT06734117) is a prospective, international, observational, longitudinal cohort study to evaluate the clinical performance of the next-generation Elecsys® Troponin T hs Gen 6 assay; the study design is presented here.</p><p><strong>Objectives: </strong>The primary objective is to determine the sensitivity of the Troponin T hs Gen 6 assay for the detection of centrally adjudicated AMI diagnosis at 3 h post-emergency department (ED) presentation. Secondary objectives include evaluation of clinical performance at 0, 1-, 5-, and 6-h post-ED presentation and validation of thresholds for a 0/1-h algorithm to rule out AMI. Exploratory objectives include validation of thresholds for a 0/1-h algorithm to rule in AMI and a 0/2-h algorithm to rule in/out AMI and evaluation of prognostic performance at 30 and 180 days.</p><p><strong>Methods: </strong>PERFORM-TSIX enrolled 5631 participants across 50 sites from the USA, Europe, China, and Japan. Patients aged ≥ 20 years presenting to the ED with symptoms/signs of acute coronary syndrome were enrolled. All patients were required to have cTn measured as part of their routine care; AMI diagnosis was adjudicated by an independent clinical events committee in accordance with the Fourth Universal Definition of MI, blinded to the results of the Troponin T hs Gen 6 assay.</p><p><strong>Conclusion: </strong>PERFORM-TSIX will determine the clinical performance of the Troponin T hs Gen 6 assay for the diagnosis of AMI in a large, diverse global population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1807-1818"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997336","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":"Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome.","authors":"Lea Kirsten, Pedro Lopez-Ayala, Emel Kaplan, Jasper Boeddinghaus, Luca Koechlin, Lourdes Herraiz-Recuenco, Gabrielle Huré, Karin Wildi, Paolo Bima, Jonas Glaeser, Carlos C Spagnuolo, Luca Crisanti, Òscar Miró, Michael Christ, Dagmar I Keller, Javier F Martin-Sanchez, Roland Bingisser, Gregor Leibundgut, Felix Mahfoud, Ivo Strebel, Christian Mueller","doi":"10.1007/s00392-026-02966-8","DOIUrl":"10.1007/s00392-026-02966-8","url":null,"abstract":"<p><strong>Background: </strong>The prevalence, characteristics, management, and long-term outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI) due to a completely occluded culprit coronary artery (NSTEMI-OMI) remain insufficiently characterised.</p><p><strong>Methods: </strong>In this international multicentre study, consecutive patients with centrally adjudicated type I NSTEMI were classified as NSTEMI-OMI if they had a TIMI flow grade of 0 or 1 or grade 2 with severe coronary narrowing (> 70%) and a high-sensitivity cardiac troponin T (hs-cTnT) ≥ 500 ng/L. Prospectively recorded chest pain characteristics, 12-lead ECG, serial hs-cTnT concentrations, time to coronary angiography/revascularisation, and 5-year mortality were compared in patients with NSTEMI-OMI versus other type I NSTEMI (NSTEMI-NOMI).</p><p><strong>Results: </strong>Among 801 patients with type I NSTEMI (median age 68 years, 22.2% female), 251 patients (31.3%) had NSTEMI-OMI. Patients with NSTEMI-OMI presented more often with persistent chest pain (56.1% vs. 37.9%, p < 0.001), more often had ST-segment depression (34.3% vs. 23.0%, p < 0.001), and exhibited higher and faster rising hs-cTnT concentrations. Time from admission to coronary angiography (median 7.2 h [IQR 4.7, 21.8] vs. 19.6 h [IQR 6.2, 27.9], p < 0.001) and coronary revascularisation (median 8.2 h [IQR 4.9, 24.0] vs. 22.0 h [IQR 6.3, 46.1], p < 0.001) were both significantly shorter in patients with NSTEMI-OMI versus NSTEMI-NOMI. Five-year mortality was comparable in patients with NSTEMI-OMI versus NSTEMI-NOMI (adjHR 1.13 [95% CI 0.78-1.63], p = 0.51).</p><p><strong>Conclusion: </strong>One in three patients with type I NSTEMI had NSTEMI-OMI. These patients more often present with very high-risk clinical, ECG, and biomarker features and receive earlier invasive management. Likely related to the latter, 5-year mortality was similar between NSTEMI-OMI and NSTEMI-NOMI.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1870-1883"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548088","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":"Three-dimensional mitral valve geometry after transcatheter edge-to-edge repair: PASCAL versus PASCAL-ACE-implications for devices selection.","authors":"Mohammed Abusharekh, Jürgen Kampf, Florian Schindhelm, Florian Jürgens, Iryna Dykun, Fadi Al-Rashid, Matthias Totzeck, Tienush Rassaf, Amir Abbas Mahabadi","doi":"10.1007/s00392-026-03031-0","DOIUrl":"https://doi.org/10.1007/s00392-026-03031-0","url":null,"abstract":"<p><strong>Background: </strong>The PASCAL® transcatheter edge-to-edge repair system (TEER) is established for mitral regurgitation (MR), with the ACE iteration tailored for complex anatomies. Comparative data are limited.</p><p><strong>Aims: </strong>To compare 3D mitral valve remodeling and procedural outcomes in patients undergoing TEER with PASCAL or PASCAL ACE device at a high-volume tertiary center.</p><p><strong>Methods: </strong>This retrospective, single-center study included 366 consecutive patients (mean age 77.7 ± 10.2 years; 57.9% male) with moderate-to-severe or severe MR treated between 2019 and 2024. Patients were stratified by device (ACE, n = 128, PASCAL, n = 238). Procedural outcomes and 3D echocardiographic remodeling were evaluated.</p><p><strong>Results: </strong>ACE-treated patients had more complex mitral anatomies and larger baseline mitral valve orifice areas (3D-MVOA, 6.55 [5.74-7.96] vs. 5.87 [4.86-7.38] cm²; p = 0.001). Relative reduction in 3D-MVOA following the first device was similar between groups (ACE - 44.5 ± 6.55% vs. PASCAL - 45.9 ± 6.61%; p = 0.066) and consistent across functional, degenerative, and mixed MR subgroups (all p > 0.05). ACE cases had a modestly smaller mean pressure gradient increase (+ 1[0-1] vs. + 1[1, 2] mmHg, p = 0.046), likely reflecting larger residual MVOAs (3.81 ± 1.11 vs. 3.38 ± 1.07 cm²; p < 0.001). Post-procedural annular remodeling by annular sphericity index was comparable (ACE 0.67 ± 0.09 vs. PASCAL 0.69 ± 0.09; p = 0.119). Both devices achieved similarly high procedural success (ACE 100% vs. PASCAL 99.6%, p = 1.00) with no procedural complications.</p><p><strong>Conclusions: </strong>In this real-world cohort, the ACE device was preferentially used in more complex mitral anatomies. Post-procedural MVOA was dictated by baseline valve anatomy rather than device configuration, with comparable relative MVOA reduction, annular remodeling, and procedural success, advocating for an anatomy-guided device selection.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105069","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":"Type 1 and type 2 NSTEMI in atrial fibrillation: insights from the HERA-FIB registry.","authors":"Mustafa Yildirim, Christian Salbach, Johannes Dürr, Matthias Mueller-Hennessen, Hugo A Katus, Norbert Frey, Evangelos Giannitsis","doi":"10.1007/s00392-026-02912-8","DOIUrl":"10.1007/s00392-026-02912-8","url":null,"abstract":"<p><strong>Background: </strong>Differentiating type 1 from type 2 non-ST-elevation myocardial infarction (NSTEMI) is clinically challenging, particularly in patients with atrial fibrillation (AF), where the 4th Universal Definition of Myocardial Infarction (UDMI) allows classification based on presumed mechanisms without mandatory coronary angiography. Real-world data from AF cohorts undergoing systematic invasive evaluation remain limited.</p><p><strong>Methods: </strong>Between 2009 and 2020, we analyzed consecutive AF patients admitted with NSTEMI to a tertiary care center. Patients undergoing early coronary angiography were included. Infarct subtypes were adjudicated according to the 4th UDMI incorporating angiographic findings. The primary objective was to determine the prevalence of type 1 and type 2 NSTEMI. The secondary endpoint was a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding.</p><p><strong>Results: </strong>Among 536 eligible patients, 438 (81.7%) underwent coronary angiography. Of these, 312 (71.2%) were classified as type 1 NSTEMI, 100 (22.8%) as type 2 NSTEMI, and 26 (5.9%) as acute myocardial injury. Type 2 NSTEMI was associated with preserved left ventricular function and less extensive coronary artery disease. Over a median follow-up of 2.21 years, composite event rates were 40.1% in type 1 and 36.0% in type 2 NSTEMI. Acute myocardial injury was associated with the highest composite event rate (65.4%) and all-cause mortality (57.7%).</p><p><strong>Conclusions: </strong>In symptomatic AF patients, type 1 NSTEMI predominates and may be underdiagnosed without angiography, which enables accurate classification and timely revascularization. Type 1 and type 2 NSTEMI confer similarly high long-term risk, while acute myocardial injury identifies a particularly high-risk subgroup requiring systematic evaluation and targeted management.</p><p><strong>Trial registration: </strong>Heidelberg Registry of Atrial Fibrillation [HERA‑FIB]; NCT05995561.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1856-1869"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688112","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":"STEMI caused by spontaneous coronary artery dissection: prevalence, patient characteristics and outcomes.","authors":"Stefan Malleier, Luise Gaede, Susanne Jung, Mohamed Marwan, Stephan Achenbach, Monique Tröbs","doi":"10.1007/s00392-026-02900-y","DOIUrl":"10.1007/s00392-026-02900-y","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognised cause of myocardial infarction. Our aim was to provide comprehensive real-world data on the prevalence of SCAD among patients who present with ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>Retrospective analysis of medical records and review of coronary angiograms allowed identification of all SCAD cases in a cohort of consecutive patients with STEMI, and review of clinical data provided further characterisation.</p><p><strong>Results: </strong>Among 2707 consecutive STEMI patients, the prevalence of SCAD was 0.9% (n = 24). In 9 cases, the diagnosis of SCAD diagnosis had been missed during clinical routine (37.5%). Compared to non-SCAD-STEMI, SCAD patients were younger (median age 53.5 vs. 66.0 years, p = 0.001) and more likely to be female (75.0% vs. 29.7%, p < 0.001). The most common symptom was typical angina (chest pain limited to the thorax, 75%). Importantly, six patients (25%) experienced cardiac arrest, either as the presenting symptom before (n = 2) or after first medical contact (n = 3), or during hospitalisation (n = 1). The most common angiographic pattern was SCAD type 4 (complete vessel occlusion, 37.5%), followed by type 2a (29.2%) and 2b (25%). Intravascular imaging was used in 25% (n = 6). 58.3% of patients with SCAD-STEMI underwent percutaneous coronary intervention (PCI). Complications occurred in 50% of PCI, mostly due to propagation of intramural hematoma. All patients survived to hospital discharge. Long-term follow-up was available in 50% of patients. While event rate was low, recurrence of SCAD did occur, in some cases after several years.</p><p><strong>Conclusion: </strong>In a Western European cohort of STEMI patients, SCAD was the underlying cause in approximately 1% of all cases. The true incidence may be higher since cardiac arrest occurred in one quarter of all patients within the cohort. Interventional treatment, while often required in SCAD-STEMI, is fraught by a high complication rate.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1845-1855"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510166","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":"Interaction between coronary lesion complexity and coronary microvascular dysfunction in the prognosis of NSTEMI patients.","authors":"Ping Lin, Yuxuan Zhang, Zining Chen, Jiamu Chen, Guohui Chen, Jiacheng Fang, Yiyue Zheng, Delong Chen, Abuduwufuer Yidilisi, Rui Ji, Xinyi Zhang, Chi Liu, Jiniu Huang, Yumeng Hu, Jianping Xiang, Tiesheng Niu, Jun Pu, Jian'an Wang, Jun Jiang","doi":"10.1007/s00392-025-02803-4","DOIUrl":"10.1007/s00392-025-02803-4","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of the American College of Cardiology/American Heart Association (ACC/AHA) lesion classification in NSTEMI remains insufficiently investigated, especially regarding its interaction with coronary microvascular disease (CMD).</p><p><strong>Methods: </strong>In 2212 NSTEMI patients, we evaluated lesion complexity by applying the modified ACC/AHA classification system and then measured post-PCI angio-IMR. The primary endpoint was major adverse cardiovascular events (MACE) at 2 years.</p><p><strong>Results: </strong>Patients with complex lesions demonstrated substantially elevated 2-year MACE rates compared to those with simple lesions (13.5% vs 7.5%, P < 0.001). Lesion complexity independently predicted MACE [HR 1.48 (95% CI (1.09-2.00)), P = 0.011]. Notably, the addition of lesion classification to a model containing the GRACE score and other clinical factors significantly improved risk prediction [C-index 0.708 (95% CI (0.672-0.744)) vs 0.693 (95% CI (0.655-0.730)), P = 0.017)]. Among non-CMD patients, complex lesions were correlated with the higher MACE incidence (10.50% vs 6.20%, P = 0.002), whereas no significant difference was observed in CMD patients (37.80% vs 26.00%, P = 0.166). Notably, CMD showed a strong association with complex lesions [OR 1.74 (95% CI (1.22-2.48)), P = 0.002]. Mediation analysis indicated that CMD accounted for 17% of the total effect of lesion complexity on MACE [proportion of effect 0.17 (95% CI (0. 07-0.39)), P = 0.002].</p><p><strong>Conclusions: </strong>The American College of Cardiology/American Heart Association lesion classification effectively stratifies risk in non-ST-segment elevation myocardial infarction, particularly among patients without coronary microvascular disease. Coronary microvascular disease is independently associated with complex coronary lesions and mediates approximately 17% of their adverse prognostic impact on major adverse cardiovascular events.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1794-1806"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586033","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":"Reduced right/left ventricular blood pool T2-ratio predicts congestive heart failure after STEMI.","authors":"Felix Troger, Mathias Pamminger, Christina Tiller, Magdalena Holzknecht, Ivan Lechner, Alex Kaser, Philip Lungenschmid, Ramona Popa, Fritz Oberhollenzer, Martin Reindl, Bernhard Metzler, Sebastian J Reinstadler, Agnes Mayr","doi":"10.1007/s00392-026-02868-9","DOIUrl":"10.1007/s00392-026-02868-9","url":null,"abstract":"<p><strong>Background: </strong>T2-mapping of the blood-pool in cardiac magnetic resonance imaging (CMR) provides important information on blood-oxygenation, and differences between right and left ventricular (RV/LV) T2-relaxation times are linked to exercise capacity in heart failure. However, there are no data available on RV/LV T2-ratio after ST-segment elevation myocardial infarction (STEMI). Our aim was to investigate the prognostic value of RV/LV T2-ratio for the development of newly diagnosed congestive heart failure (CHF) post-STEMI.</p><p><strong>Methods: </strong>Six hundred four patients were enrolled after revascularized first-time STEMI; all patients underwent CMR within four days afterwards (interquartile range (IQR) 2-5). T2 relaxation times were measured in the RV and LV blood pool on short-axis T2-maps; T2-ratio was calculated as T2_RV/T2_LV. Telephonic follow-ups were performed at a median observation interval of 3.0 years. CHF was defined as cardiac decompensation symptoms requiring i.v. diuretics.</p><p><strong>Results: </strong>Median T2-ratio was 73% (IQR 65-80) and significantly lower in patients with newly diagnosed CHF (69% vs. 73%, p = 0.019). Dichotomized at 60% (10th percentile), patients with a reduced T2-ratio experienced CHF significantly more often (19% vs. 6%, p < 0.001) and sooner (55 vs. 485 days, p < 0.001) and were significantly older, had larger infarcts, higher peak troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP), lower LV-/RV-ejection fraction, and more commonly microvascular injuries (all p < 0.05). In logistic regression, T2-ratio < 60% emerged as an independent prognostic marker in multiparametric models including classic CHF risk factors. Addition of RV/LV T2-ratio to NT-proBNP resulted in a net reclassification improvement of 0.32 (95% CI 0.06-0.57, p = 0.016).</p><p><strong>Conclusion: </strong>CMR-derived RV/LV T2-ratio is an easily applicable tool bearing prognostic potential for CHF after STEMI.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1819-1830"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212300","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":"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":"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":"1759-1774"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","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":"Cocaine-induced acute myocardial infarction: angiographic features and outcomes.","authors":"Michael Würdinger, Davide Di Vece, Victor Schweiger, Iva Koleva, Barbara E Stähli, Jelena-Rima Ghadri, Erik W Holy, Christian Templin","doi":"10.1007/s00392-025-02677-6","DOIUrl":"10.1007/s00392-025-02677-6","url":null,"abstract":"<p><strong>Background: </strong>Cocaine is a global health burden and the cause of a significant number of emergency department consultations. Its association with acute myocardial infarction (AMI) is known, however, data are still rare. The aim of this study was to define causative pathologies behind cocaine-induced AMI (CI-AMI) and to analyze their clinical features.</p><p><strong>Methods: </strong>Patients with the diagnosis of CI-AMI were retrospectively identified at the University Hospital Zurich between 1997 and 2023. The angiograms were reviewed to confirm the diagnosis. Coronary microvascular dysfunction (CMD) was separately evaluated by an angiography-based analysis (AngioPlus Core, Microport Medical Co.). The primary endpoint was rates of major adverse cardiovascular events (MACE) at 30 days, 1 year, and 2 years.</p><p><strong>Results: </strong>Forty-five cases of CI-AMI were identified. Twelve patients (27%) were diagnosed with plaque rupture and intraluminal thrombus, eight (18%) with coronary artery disease (CAD) without thrombus formation, eight (18%) with spontaneous coronary artery dissection, six (13%) with CMD, four (9%) with coronary vasospasm, and four patients (9%) with Takotsubo syndrome. The cause of CI-AMI remained unclear in three patients (6%). No clinically useful predictors of CAD were identified. 91% of patients had values associated with CMD during angiography-based analysis, independently from the etiology of CI-AMI. 49% of cases were treated by revascularization, and the number of MACE was high (16%, 28%, and 34% at 30 days, 1 year, and 2 years).</p><p><strong>Conclusions: </strong>CI-AMI is a rare, but important cause of acute coronary syndromes (ACS). CAD represents the most frequent etiology of AMI, but there is a broad range of other entities. Patients suffer from a significant number of adverse events.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1747-1758"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149519","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":"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":"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":"1723-1734"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562127/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}