Clinical Research in Cardiology最新文献

{"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}

{"title":"Impact of renal dysfunction on immediate versus staged revascularization of non-culprit lesions in patients with ST segment elevation myocardial infarction: a pre-specified subgroup analysis of the randomized MULTISTARS AMI trial.","authors":"Miklos Rohla, Kurt Huber, Ferdinando Varbella, Axel Linke, Bettina Schwarz, Stephan B Felix, Moritz Seiffert, Rahel Kesterke, Peter Nordbeck, Bernhard Witzenbichler, Irene M Lang, Mirjam Kessler, Christian Valina, Alban Dibra, Philipp Jakob, Marco Moccetti, Matteo Vercellino, Luise Gaede, Lorenz Bott-Flügel, Julia Stehli, Alessandro Candreva, Francesco Paneni, Christian Templin, Matthias Schindler, Manfred Wischnewsky, Greca Zanda, Giorgio Quadri, Norman Mangner, Aurel Toma, Giulia Magnani, Peter Clemmensen, Thomas F Lüscher, Thomas Münzel, P Christian Schulze, Karl-Ludwig Laugitz, Wolfgang Rottbauer, Franz-Josef Neumann, Steffen Schneider, Thomas Riemer, Franz Weidinger, Stephan Achenbach, Gert Richardt, Adnan Kastrati, Ian Ford, Frank Ruschitzka, Barbara E Stähli","doi":"10.1007/s00392-026-02875-w","DOIUrl":"10.1007/s00392-026-02875-w","url":null,"abstract":"<p><strong>Background: </strong>Renal dysfunction might affect outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>In MULTISTARS AMI, patients with STEMI and MVD were randomized to immediate or staged PCI of non-culprit lesions. In this pre-specified analysis, patients were stratified according to the presence of renal dysfunction at baseline, defined at an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m². Patients with an eGFR < 30 ml/min/1.73 m² were excluded from the trial. The primary endpoint was a composite of death, non-fatal myocardial infarction, stroke, unplanned revascularization, or hospitalization for heart failure at 1 year.</p><p><strong>Results: </strong>In MULTISTARS AMI, 108 (13%) of 832 patients had renal dysfunction. The primary endpoint occurred more frequently in patients with renal dysfunction (19.4% vs. 11.2%, unadjusted HR 1.82, 95% CI 1.13-2.94), primarily driven by higher rates of death. Among patients with renal dysfunction, the rates of the primary end point were 14.5% and 24.5% in the immediate and staged PCI groups (unadjusted HR 0.55, 95% CI 0.23-1.33). There was no interaction between renal dysfunction and the randomized treatment assignment with respect to the primary end point (adjusted HR 1.30, 95% CI 0.8-2.20, p_int 0.82). The occurrence of acute renal insufficiency was statistically similar in patients with renal dysfunction who underwent immediate and staged PCI (10.9% vs. 18.9%, unadjusted HR 0.61, 95% CI 0.22-1.72, p_int 0.09). Renal dysfunction at baseline emerged as a strong risk factor for the development of acute renal insufficiency (adjusted HR 5.0, 95% CI 2.30-10.70, p < 0.01).</p><p><strong>Conclusions: </strong>Outcomes with immediate compared to staged multivessel PCI did not appear significantly altered by the presence of renal dysfunction at baseline. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275).</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1831-1844"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389676","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 subthreshold troponin levels and temporal trends on short term adverse cardiovascular outcomes in patients discharged from the emergency department: a RACE-IT trial substudy.","authors":"Muhammad Ahmad Qureshi, Bernard Cook, Benjamin Brennan, Joseph Miller, James McCord","doi":"10.1007/s00392-025-02789-z","DOIUrl":"10.1007/s00392-025-02789-z","url":null,"abstract":"<p><strong>Background: </strong>High-sensitivity cardiac troponin I assays enable early exclusion of myocardial infarction in the emergency department. However, the clinical implications of detectable troponin values below the 99th percentile upper reference limit (4-18 ng/L) remain unclear.</p><p><strong>Objective: </strong>To assess the association between subthreshold troponin levels and 30-day outcomes in patients from the RACE-IT trial, using exact troponin values when available.</p><p><strong>Methods: </strong>This post-hoc analysis of the RACE-IT stepped-wedge randomized controlled trial included patients with troponin ≤ 18 ng/L across nine EDs. Patients were stratified by initial troponin, peak value, absolute change, and percent change. The primary outcome was a 30-day composite of all-cause death, acute MI, percutaneous coronary intervention, and coronary artery bypass grafting. Logistic regression analysis after adjusting for age, sex, race, and coronary artery disease was performed.</p><p><strong>Results: </strong>Among 19,194 patients with troponin ≤ 18 ng/L, 117 (0.6%) experienced the composite outcome. Higher troponin levels were associated with increased event rates in unadjusted analyses. Adjusted analyses showed no independent associations overall, though patients whose highest troponin values fell within the ≥ 11- ≤ 18 ng/L range continued to demonstrate significantly worse outcomes than those with lower peak levels. Elevated troponin values correlated with older age, male sex, and greater comorbidity burden.</p><p><strong>Conclusion: </strong>In this post-hoc analysis of patients with troponin values below the 99th percentile URL, absolute levels and temporal changes were not independently associated with 30-day adverse outcomes. These findings support the use of subthreshold troponin values in rapid rule-out protocols, emphasizing the need to consider clinical context and comorbidities in risk assessment.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1785-1793"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586012","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":"Echocardiographic features, antithrombotic therapy, and association with outcomes in patients with left ventricular thrombus after myocardial infarction: a single-center retrospective study.","authors":"Mariya Maslarska-Martens, Celina Blank, Tian Li, Marius Wessinger, David Hesselbarth, Diona Gjermeni, Kilian Franke, Christian Valina, Nikolaus Jander, Sebastian Grundmann, Dennis Wolf, Dirk Westermann, Christoph B Olivier","doi":"10.1007/s00392-026-03020-3","DOIUrl":"https://doi.org/10.1007/s00392-026-03020-3","url":null,"abstract":"<p><strong>Introduction and aim: </strong>Left ventricular thrombus (LVT) is a rare but threatening complication after acute myocardial infarction (MI). Guidelines recommend oral anticoagulation for at least 3-6 months. This retrospective, single-center cohort study describes the incidence of LVT, the antithrombotic regimen, and the association with LVT regression and clinical outcomes.</p><p><strong>Methods: </strong>Patients admitted between January 1st, 2008, and December 31st, 2022, with MI were screened for the presence of LVT. Primary outcomes were the incidence of LVT, secular trends of oral anticoagulation prescription at discharge (direct oral anticoagulants vs Vitamin-K-antagonists), and change of LVT size or complete regression at follow-up examination. Secondary outcomes were all-cause death, embolic events associated with the LVT diagnosis, and bleeding events (BARC ≥ 2).</p><p><strong>Results: </strong>A total of 19,964 patients admitted with MI between 2008 and 2022 were identified, of whom 166 (0.83%) had a confirmed LVT. Eighty-five patients were prescribed a VKA, 49 patients a DOAC, and 26 patients another form of anticoagulation. Transthoracic echocardiography follow-up was available for 120 patients, of whom 95 (79%) showed complete thrombus resolution. No statistically significant difference in complete thrombus resolution was detected between DOAC and VKA groups (87% vs. 79%; p = 0.42). Thirty-eight clinical events (bleeding, all-cause death, and embolic events) occurred within 12 months after LVT diagnosis without significant differences between DOAC and VKA.</p><p><strong>Conclusion: </strong>DOAC use increased over time, with no statistically significant difference in early complete thrombus resolution or clinical events compared with VKA.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105064","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":"Long-term LDL-C lowering and treatment persistence with inclisiran: 3-year follow-up from the German Inclisiran Network.","authors":"Umidakhon Makhmudova, Ulrike Schatz, Paulina Stuerzebecher, Friederike Schumann, Uta Kästner, Juliane Mensch, Jens Arndt Geiling, Franz Haertel, Ksenija Stach, Anja Vogt, Andrea Bässler, David Sinning, Ursula Kassner, Elisabeth Steinhagen-Thiessen, P Christian Schulze, Ulf Landmesser, Ulrich Laufs, Oliver Weingärtner","doi":"10.1007/s00392-026-03028-9","DOIUrl":"https://doi.org/10.1007/s00392-026-03028-9","url":null,"abstract":"<p><strong>Background: </strong>Inclisiran, a small interfering RNA targeting PCSK9, has demonstrated durable LDL-C lowering in clinical trials. However, real-world evidence on its long-term effectiveness and treatment persistence remains limited.</p><p><strong>Aim: </strong>To evaluate LDL-C reductions, treatment persistence, and reasons for therapy discontinuation over a follow-up period of up to 3 years in a real-world lipid clinic cohort.</p><p><strong>Methods: </strong>We analyzed data from ten lipid clinics participating in the German Inclisiran Network (GIN). Adults with at least one inclisiran dose and follow-up lipid measurements were included. LDL-C levels were assessed during 3 years of follow-up (median 33 months, IQR 27-39). Discontinuation rates, therapy changes, and adverse effects were documented.</p><p><strong>Results: </strong>Among 109 patients (mean age 63.8 years, 43.1% female). The cohort comprised a heterogeneous population, with only ~ 30% receiving statins due to statin intolerance. Median (95% CI) LDL-C reduction from baseline to nadir was - 46% (- 60.8 to - 33.8%). Median for LDL-C reduction for each individual during the follow-up was - 28% (- 33.8 to - 24.2%). High interindividual and intraindividual variability in LDL-C response was observed. Over 3 years, ~ 30% of patients discontinued inclisiran, most commonly due to lack of efficacy (15.6%), adverse effects (7.3%), or a combination of both (1.8%). Those who discontinued due to lack of efficacy were older and had less background lipid-lowering therapy. Females were more likely than males to discontinue due to adverse effects. In a multivariable logistic regression model, older age was a predictor of higher discontinuation rates, whereas concomitant LLT use was associated with lower discontinuation rates. Notably, ~ 87% of patients with statin intolerance did not exhibit any adverse effects with inclisiran.</p><p><strong>Conclusions: </strong>In a heterogeneous real-world population, inclisiran achieved significant LDL-C reductions but with marked inter- and intraindividual variability. A notable proportion of patients discontinued therapy, highlighting the importance of individualized treatment strategies.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073717","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":"Not all mental disorders matter equally in peripheral arterial disease: Dementia drives prognosis and care disparities.","authors":"Esra Tokur Sonuvar, Dierk Scheinert, Christian Günster, Patrik Dröge, Thomas Ruhnke, Sabrina Friebe, Toralf Kirsten, Eva Freisinger","doi":"10.1007/s00392-026-03027-w","DOIUrl":"https://doi.org/10.1007/s00392-026-03027-w","url":null,"abstract":"<p><strong>Background and aims: </strong>Mental Disorders are increasingly recognized as modifiers of cardiovascular outcomes, yet their differential impact in peripheral arterial disease (PAD) remains poorly understood. We investigated the prevalence, treatment patterns, and prognostic relevance of depression, anxiety disorders, and dementia in patients hospitalized for PAD.</p><p><strong>Methods: </strong>In this nationwide cohort study based on claims data from AOK - Die Gesundheitskasse, 99,415 patients hospitalized for PAD between January 1, 2019 and December 31, 2020 were identified. Treatment patterns and clinical outcomes were assessed using multivariable-adjusted analyses and Cox regression models.</p><p><strong>Results: </strong>Overall, 47% of patients hospitalized for PAD had concomitant depression, anxiety, or dementia (D-A-D). Patients with these mental disorders were more frequently female, presented with more advanced PAD stages, and had a higher cardiovascular risk profile. However, marked heterogeneity between mental conditions was observed. Dementia was associated with the most pronounced treatment disparities, including substantially lower rates of revascularization and statin therapy despite more advanced disease at presentation. Dementia further emerged as a strong independent predictor of all-cause mortality (HR 1.57-1.62; p < 0.001) and amputation and/or death (HR 1.49-1.56; p < 0.001). In contrast, depression showed only modest associations with adverse outcomes after adjustment, while anxiety disorders were not consistently associated with increased risk.</p><p><strong>Conclusions: </strong>Mental Disorders in PAD are not prognostically homogeneous. Dementia identifies a particularly vulnerable and undertreated PAD population characterized by substantial therapeutic disparities and markedly adverse clinical outcomes, highlighting an important and underrecognized gap in vascular care.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036767","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":"Relationship between a small aortic annulus and clinical and quality-of-life outcomes in patients undergoing TAVR.","authors":"Ottavia Cozzi, Daijiro Tomii, Jonas Lanz, Dik Heg, Holger Thiele, Won-Keun Kim, Michael Joner, Christian Thilo, Stefan Toggweiler, Bernard Prendergast, Stephan Windecker, Thomas Pilgrim","doi":"10.1007/s00392-026-03025-y","DOIUrl":"https://doi.org/10.1007/s00392-026-03025-y","url":null,"abstract":"<p><strong>Background: </strong>A small aortic annulus is associated with impaired hemodynamics after transcatheter aortic valve replacement (TAVR). The impact on long-term clinical or patient-centered outcomes remains unclear.</p><p><strong>Aims: </strong>To evaluate the association between aortic annulus size and long-term clinical outcomes and patient-reported health status after TAVR.</p><p><strong>Methods: </strong>In this post-hoc analysis of the multicenter SCOPE I randomized trial, patients were categorized according to computed tomography-derived annular size (small ≤ 430 mm², larger > 430 mm²). Outcomes included clinical events, disease-specific health status assessed with the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) and an integrated patient-centered outcome defined as being alive with good health status (KCCQ-OS ≥ 75 without a decline > 10 points from baseline).</p><p><strong>Results: </strong>Among 732 patients, 323 (44.1%) had a small and 409 (55.9%) larger annulus. Patients with a small annulus were more frequently women and had slightly higher surgical risk. Despite higher transvalvular gradients and a higher prevalence of prosthesis-patient mismatch, patients with a small annulus had no differences in all-cause mortality (18.6% vs 25.4%), heart-failure hospitalization (14.9% vs 15.6%), or patient-reported health status at 3 years, and a comparable probability of being alive with good health status (46.5% vs 43.2%; OR 0.95, 95% CI 0.63-1.44, p = 0.81). In an exploratory factorial analysis, a small annulus treated with a balloon-expandable valve was associated with a lower probability of this integrated outcome (RR 0.59, 95% CI 0.41-0.85; p for interaction = 0.004).</p><p><strong>Conclusions: </strong>Patients with small aortic annuli experience comparable long-term survival and quality-of-life recovery after TAVR. Exploratory analyses suggest that valve type may influence patient-centered outcomes in this population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029985","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":"Effectiveness and clinical impact of functional post-PCI optimization-a systematic review and individual patient-data meta-analysis.","authors":"Annemieke C Ziedses des Plantes, Tara Neleman, Abdul Hakeem, Barry F Uretsky, Shiv K Agarwal, Kristin Miller, Damien Collison, Keith Oldroyd, William Wijns, Antonio Maria Leone, Francesco Burzotta, Carlo Trani, Domenico Galante, Massoud A Leesar, Sanne E Hoeks, Nicolas M Van Mieghem, Joost Daemen","doi":"10.1007/s00392-026-03009-y","DOIUrl":"https://doi.org/10.1007/s00392-026-03009-y","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal post-PCI FFR values are associated with impaired clinical outcomes. The determinants and clinical impact of FFR improvement through optimization remain unclear. This study sought to evaluate the effect of post-PCI optimization on fractional flow reserve (FFR) values and to identify predictors of successful optimization.</p><p><strong>Methods: </strong>We performed a systematic review and individual patient data (IPD) meta-analysis including patients who underwent PCI with drug-eluting stents with paired FFR measurements before and after post-PCI optimization. A one-stage meta-analysis was performed using mixed-effects models. The primary endpoint was the absolute increase in FFR after optimization.</p><p><strong>Results: </strong>Out of 1945 screened studies, a total of 11 studies met the selection criteria for the present meta-analysis and IPD was provided from 8 studies. In 314 patients, the median (interquartile range) FFR value significantly improved from 0.81 (0.75-0.85) to 0.86 (0.81-0.89) after optimization (p < 0.001). In multivariable analysis, LAD vessel and higher post-PCI FFR values were negative predictors for the magnitude of FFR increase, whereas optimization using an additional stent was associated with a larger FFR increase as compared to post-dilatation alone. The effect of additional stenting was more pronounced in patients with lower post-PCI FFR values.</p><p><strong>Conclusions: </strong>Post-PCI optimization after angiographically successful PCI resulted in a significant increase in post-PCI FFR. The success of optimization of suboptimal FFR values was associated with target vessel location, initial post-PCI FFR value and optimization method.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029993","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":"Interleukin-8 and other neutrophil-related biomarkers are associated with 1-year mortality in patients with acute myocardial infarction.","authors":"Yu-Jen Wang, Michael A Matter, Valentina A Rossi, Dik Heg, Sarah Costantino, Francesco Paneni, Camilla Gallino, Barbara E Stähli, Lorenz Räber, Stephan Windecker, François Mach, Baris Gencer, Roland Klingenberg, Nicolas Rodondi, David Nanchen, Mitchell P Levesque, Olga V Demler, Frank Ruschitzka, Christian M Matter","doi":"10.1007/s00392-026-03026-x","DOIUrl":"https://doi.org/10.1007/s00392-026-03026-x","url":null,"abstract":"<p><strong>Background: </strong>Interleukin-8 (IL-8) triggers early inflammatory responses upon tissue injury, activating neutrophils that release neutrophil extracellular traps with cell-free DNA (cfDNA) and myeloperoxidase (MPO). Injury upon acute myocardial infarction (AMI) induces an early excessive inflammatory response. The value of IL-8 and neutrophil-related biomarkers for AMI patient outcomes is incompletely understood.</p><p><strong>Methods: </strong>AMI patients sampled ≤ 24 h after symptom onset were included from SPUM-ACS cohort. One hundred twelve cases with all-cause mortality or recurrent AMI within 1 year were matched 1:1 to event-free controls by age, sex, AMI subtype, symptom onset time, and recruiting sites.</p><p><strong>Results: </strong>Cases showed higher IL-8 (median: 66.82 vs. 41.24 pg/mL; p = 0.001), cfDNA (393.9 vs. 223.8 ng/mL; p < 0.001), MPO (683.4 vs. 602.2 ng/mL; p = 0.030), and neutrophil-to-lymphocyte ratio (NLR) than controls (6.22 vs. 4.76; p = 0.013). IL-8 and cfDNA were higher in the death subgroup than recurrent AMI (IL-8: 71.16 vs. 51.52 pg/mL; p = 0.026; cfDNA: 420.5 vs. 239.7 ng/mL; p = 0.030). Notably, IL-8 peaked in the hyper-acute phase (< 6 h), earlier than high-sensitivity troponin T (hsTnT). This aligned with its associations with death or recurrent AMI (OR = 1.62; p = 0.021), death (OR = 2.14; p = 0.019), and early presenters (< 6 h, OR = 2.65; p = 0.008) after adjusting for confounders (estimated glomerular filtration rate [eGFR], high-sensitivity C-reactive protein [hsCRP], N-terminal pro-B-type natriuretic peptide [NT-proBNP], and hsTnT). IL-8, along with cfDNA, NLR, and hsCRP clustered in patients with increased Killip Class and worse outcomes.</p><p><strong>Conclusions: </strong>IL-8 and neutrophil-related biomarkers were associated with 1-year mortality in AMI patients, especially in the hyper-acute phase.</p><p><strong>Clinical trial registration: </strong>NCT01000701.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024033","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}