Current vascular pharmacology最新文献

{"title":"Anti-angiogenic Therapy at the Vascular Crossroads: Tumor Vessel Normalization, Excessive Pruning, and Systemic Vascular Toxicity.","authors":"Jiahao Lu, Junxiang Xu, Yijin Chang, Dong Liu, Changsheng Chen","doi":"10.2174/0115701611508994261012075657","DOIUrl":"https://doi.org/10.2174/0115701611508994261012075657","url":null,"abstract":"<p><p>Tumor angiogenesis contributes to tumor growth, metastasis, and treatment resistance, but the newly formed vessels are often structurally abnormal and functionally inefficient. Antiangiogenic therapy, particularly inhibition of Vascular Endothelial Growth Factor (VEGF) signaling, is now used in the treatment of multiple cancers. Its vascular effects depend strongly on the extent of angiogenic inhibition. Moderate inhibition may temporarily improve the structure and function of abnormal tumor vessels. This vascular normalization can improve perfusion, oxygenation, immune cell infiltration, and drug delivery in selected tumor types and treatment settings. More extensive vessel pruning can have the opposite effect, reducing perfusion, worsening hypoxia, and favoring adaptive resistance. VEGF inhibition also affects normal vessels because physiological angiogenic signaling is required for endothelial homeostasis. Disruption of this signaling contributes to hypertension, thromboembolism, renal injury, cardiovascular complications, and cerebrovascular events. In this narrative review, the mechanisms that shape tumor vascular remodeling and compare the vascular effects of anti-angiogenic and other vascular-modulating anticancer therapies in tumors and normal tissues are examined. Particular attention is given to the distinction between tumor-vessel normalization and vascular injury in normal tissues, as well as treatment scheduling, combination strategies, targeted delivery, and vascular-response biomarkers.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of the Vascular Pathophysiology of Migraine: Should We Consider Statins as a Treatment Option?","authors":"Ksenija Zecevic Crvenko, Dimitri P Mikhailidis, Milovan Roganović, Emir Muzurović","doi":"10.2174/0115701611519916260928103036","DOIUrl":"https://doi.org/10.2174/0115701611519916260928103036","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Migraine is a primary headache disorder that affects more than a billion people worldwide and can severely impact quality of life. Inflammation and endothelial dysfunction in the trigeminovascular system are the suggested underlying mechanisms. Statins, beyond their lipid-lowering effects, exhibit pleiotropic properties including anti-inflammatory, antioxidative, and endothelial-modulating effects, which may be relevant to migraine pathophysiology. This narrative review evaluates current evidence on the efficacy of statins in migraine prophylaxis, treatment, and prevention of associated vascular events.</p><p><strong>Methods: </strong>A literature search was conducted using MEDLINE (via PubMed) for English-language articles published between 1997 and June 2026 using the terms \"migraine,\" \"statins,\" \"pathophysiology of migraine,\" \"neuroinflammation,\" and \"migraine treatment\".</p><p><strong>Results: </strong>The majority of studies endorse the use of statins in individuals with migraines, noting that their positive impact on migraines and cardiovascular risk outweighs any adverse effects.</p><p><strong>Discussion: </strong>Considering the increased cardiovascular risk in migraine sufferers compared with those without migraine, statins may play a beneficial role in both migraine management and cardiovascular risk reduction. It is surprising that the role of statins in a common disease like migraine, which is also associated with an increased risk of vascular events, does not include definitive evidence.</p><p><strong>Conclusion: </strong>Statins might be considered for migraine treatment and prevention in individuals with chronic migraine, aura, hyperlipidemia, hypertension, a family history of cardiovascular disease, or other cardiovascular risk factors. We hope that the present article will encourage further research to establish if statins have a definite role in the treatment of migraine.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Pioglitazone in Improving Cognitive Function Among Stroke Patients: A Prospective, Double-Blind, Randomized Controlled Trial.","authors":"Ian Osoro, Robert S Wilson, Muhasaparur Ganesan Rajanandh","doi":"10.2174/0115701611506984260923073428","DOIUrl":"https://doi.org/10.2174/0115701611506984260923073428","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke patients are at a higher risk of developing cognitive difficulties. Insulin resistance has been identified as a risk factor for decline in cognition, raising the possibility that pioglitazone, an insulin-sensitizing agent, might benefit stroke patients with cognitive impairment by improving insulin sensitivity.</p><p><strong>Methods: </strong>In this single-center, double-blind, randomized controlled trial, 131 eligible patients with post-stroke cognitive impairment were randomized to receive either standard therapy plus pioglitazone (15 mg once daily) or standard therapy alone plus matching placebo. Of the 131 randomized participants, 111 completed the study and were included in the per-protocol analysis.</p><p><strong>Results: </strong>No statistically significant between-group differences were observed for the primary outcomes, including the Montreal Cognitive Assessment (MoCA) score (p = 0.057), P300 latency (ms) (p = 0.64), P300 amplitude (μV) (p = 0.321), and plasma Aβ42/Aβ40 ratio (p = 0.26). Furthermore, 25 (45.5%) participants in the intervention arm and 13 (23.2%) participants in the control arm experienced at least one Adverse Drug Reaction (ADR) (p = 0.63).</p><p><strong>Discussion: </strong>The study findings indicated that a low dose of pioglitazone did not significantly improve cognitive function over a 12-month period. The proposed neuroprotective effects of pioglitazone reported in previous studies were not reflected in the outcomes assessed in this trial.</p><p><strong>Conclusion: </strong>Among stroke patients with cognitive impairment, pioglitazone as an add-on therapy did not significantly improve cognitive function as measured by MoCA scores, P300 Event-Related Potentials (ERPs), and plasma amyloid-beta biomarkers over a 1-year period. (Clinical Trial number: CTRI2024/09/074281) (Date of registration: 24/09/2024).</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic Therapy in Patients with Chronic Coronary Disease on Anticoagulation: Evidence from Contemporary Trials.","authors":"Sukhila Reddy, Lakshmi Kattamuri, Muhammad Asif, Debabrata Mukherjee","doi":"10.2174/0115701611491082260918125921","DOIUrl":"https://doi.org/10.2174/0115701611491082260918125921","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic coronary disease (CCD) commonly coexists with long-term oral anticoagulation (OAC), particularly for atrial fibrillation (AF). Combination antiplatelet therapy increases bleeding, whereas ischemic protection with OAC alone remains a concern. We critically appraised contemporary evidence and guidelines to define optimal long-term maintenance therapy.</p><p><strong>Methods: </strong>We synthesized WOEST, PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, AFIRE, OAC-ALONE, PRAEDO-AF, EPIC-CAD, AQUATIC, and meta-analyses. Because foundational trials included recent ACS/PCI populations, evidence was analyzed as early/recent ACS or PCI (≤1 year) and late/stable CAD (>1 year post-PCI or non-revascularized CCD). Designs, populations, ischemic, bleeding, and mortality outcomes were systematically compared within the 2023 ACC/AHA CCD and AF guidelines.</p><p><strong>Results and discussion: </strong>Early trials supported aspirin withdrawal and DOAC plus single P2Y12 inhibition after PCI. Later trials showed full-dose OAC monotherapy was noninferior to OAC plus single antiplatelet therapy beyond 6-12 months or in stable non-revascularized CCD for preventing myocardial infarction, stroke, and systemic embolism, while reducing major and clinically relevant nonmajor bleeding and, sometimes, mortality. Meta-analysis showed fewer cardiovascular death, myocardial infarction, stroke, and major bleeding events without excess ischemia.</p><p><strong>Conclusion: </strong>OAC monotherapy should be the default for most patients, reserving antiplatelets for individualized high-ischemic/low-bleeding-risk scenarios, while recognizing predominantly East Asian and limited European evidence.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing the \"Faucet\" and the \"Drain\": A Dual-Target Pharmacological Perspective on Fluid Dynamics in High-Altitude Cerebral Edema.","authors":"Yue Dong, Qinghai Shi, Zhihao Zou","doi":"10.2174/0115701611497492260914050320","DOIUrl":"https://doi.org/10.2174/0115701611497492260914050320","url":null,"abstract":"<p><p>High-Altitude Cerebral Edema (HACE) is a potentially fatal microvascular complication caused by severe hypobaric hypoxia. For decades, the pharmacological management of HACE has adopted non-specific systemic drugs to prevent Blood-Brain Barrier (BBB) leakage. However, this classic \"leaky faucet\" model addresses only part of the neurovascular problem and may overlook the brain's intrinsic \"drainage\" mechanisms, such as the glymphatic clearance system and cerebral venous compliance. Recent research suggests that hypoxia degrades endothelial tight junctions through autophagy and necroptosis, and may also hinder fluid outflow through the depolarization of aquaporin 4 (AQP4) and venous congestion. From this perspective, a potential pharmacological paradox emerges: acetazolamide, a first-line preventive drug, has been proposed to act as a non-specific inhibitor of AQP4 and could, in theory, attenuate the clearance function of the glymphatic system, although direct clinical evidence for this effect remains limited. We propose a \"dual-target\" pharmacological strategy that seals the microvascular endothelium and enhances the clearance of glymphatic fluid. Combined with emerging vascular-targeted drugs, nanomedicines, and non-invasive delivery methods, this approach may offer a complementary framework for the prevention and treatment of severe high-altitude-related neurological diseases.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Importance of Albuminuria Reduction in Multimorbid Older Adults with Cardiovascular Disease: SGLT2 Inhibitor Therapy and Implications for Polypharmacy.","authors":"Francisco Epelde","doi":"10.2174/0115701611487581260727114319","DOIUrl":"https://doi.org/10.2174/0115701611487581260727114319","url":null,"abstract":"<p><strong>Background: </strong>Albuminuria is a marker of kidney microvascular injury and systemic endothelial dysfunction, linked to kidney and cardiovascular outcomes, particularly Heart Failure (HF). In adults aged ≥75 years with multimorbidity and Cardiovascular Disease (CVD), albuminuria identifies a high-risk cardiorenal phenotype and may be a therapeutic target.</p><p><strong>Objective: </strong>To review the clinical significance of albuminuria reduction in multimorbid older adults with cardiopathy and nephropathy, emphasizing mechanistic rationale, prognostic implications, sodium-glucose cotransporter-2 (SGLT2) inhibitor evidence, and polypharmacy-aware implementation, with canagliflozin discussed as an evidence-based example rather than as a preferred agent.</p><p><strong>Methods: </strong>Narrative review of Chronic Kidney Disease (CKD), diabetes, and HF guidance; observational cohorts; Randomized Controlled Trials (RCTs); and meta-analyses evaluating albuminuria as a risk marker, its association with HF, and albuminuria-lowering therapies with outcome evidence.</p><p><strong>Results: </strong>Albuminuria predicts mortality, CKD progression, and HF events across estimated Glomerular Filtration Rate (eGFR) strata, including high-normal Urinary Albumin-to-Creatinine Ratio (UACR) ranges. SGLT2 inhibitors reduce HF hospitalization and slow CKD progression. Canagliflozin- specific evidence derives mainly from the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial and the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program, while dapagliflozin and empagliflozin trials provide important class-context evidence.</p><p><strong>Conclusions: </strong>In older multimorbid adults with CVD, HF, and CKD, albuminuria reduction with outcome-proven therapies may support kidney protection and HF risk reduction. SGLT2 inhibitors are evidence-based options when individualized monitoring and polypharmacy-aware implementation are applied; canagliflozin is one such option with substantial evidence in albuminuric diabetic CKD, but no superiority over other SGLT2 inhibitors is implied.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation in the Aging Brain: Navigating the Intersection of Dementia, Cerebrovascular Risk, and Therapeutic Uncertainty.","authors":"Antonella Mameli, Francesco Marongiu, Doris Barcellona","doi":"10.2174/0115701611457906260714113521","DOIUrl":"https://doi.org/10.2174/0115701611457906260714113521","url":null,"abstract":"<p><strong>Background: </strong>The progressive aging of the global population has been accompanied by a parallel increase in both dementia and atrial fibrillation (AF), two conditions that frequently coexist and are linked through complex cerebrovascular and systemic mechanisms. Beyond overt ischemic stroke, AF has been increasingly associated with subclinical brain injury and cognitive decline.</p><p><strong>Objective: </strong>This review examines the relationship between AF, oral anticoagulation, and cognitive outcomes, with a particular focus on elderly patients and those with cognitive impairment.</p><p><strong>Methods: </strong>Study Design and Literature Search Strategy: This article is a narrative review based on a structured literature search conducted in PubMed/MEDLINE, Scopus, and relevant guideline databases. The search focused on studies addressing atrial fibrillation, oral anticoagulation, cognitive decline, dementia, silent cerebral infarction, cerebral microbleeds, and neurovascular injury. Priority was given to systematic reviews, meta-analyses, randomized controlled trials, observational cohort studies, and current international guidelines. Relevant English-language articles published up to 2025 were considered. We performed a narrative synthesis of the current evidence addressing the biological pathways connecting AF and neurodegeneration, as well as clinical studies evaluating the impact of oral anticoagulant therapy on cognitive trajectories.</p><p><strong>Results: </strong>Oral anticoagulation remains central to stroke prevention in AF, yet its role in modulating cognitive decline remains incompletely defined. Observational data suggest that direct oral anticoagulants (DOACs) may be associated with a lower incidence of dementia, potentially through the reduction of microembolism and silent cerebral ischemia. However, these findings are not conclusive and should be interpreted with caution. Concerns regarding bleeding risk, particularly intracerebral hemorrhage, continue to influence treatment decisions, especially in frail and cognitively impaired populations.</p><p><strong>Conclusion: </strong>Managing anticoagulation in patients with AF and cognitive impairment requires a careful balance between preventing blood clots and minimizing bleeding risk. A comprehensive, patientfocused approach, supported by multidisciplinary collaboration, may improve clinical decisionmaking. More research is needed to understand the long-term cognitive effects of anticoagulant treatments in this vulnerable group.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericarditis/Myopericarditis/Pericardial Effusion: A Contemporary Approach to Diagnosis and Management.","authors":"Antonis A Manolis, Theodora A Manolis, Apostolos Vouliotis, Antonis S Manolis","doi":"10.2174/0115701611435345260707064226","DOIUrl":"https://doi.org/10.2174/0115701611435345260707064226","url":null,"abstract":"<p><p>Pericarditis is a common disease caused by various factors such as viral infections, systemic diseases, or drugs. A diagnosis of pericarditis is rendered in up to 5% of Emergency Room (ER) visits for non-ischemic chest pain. It is diagnosed when pleuritic chest pain is present, accentuated in the supine position, accompanied by ECG changes comprising new extensive ST-segment elevation and PR depression, a pericardial friction rub, and new or increased pericardial effusion on echocardiography. In North America and Western Europe, the most common causes of acute pericarditis are idiopathic or viral, followed by post-procedural (iatrogenic) pericarditis, radiation therapy, and cardiac surgery. Tuberculosis is the most common cause of pericarditis in endemic areas and is managed with antituberculosis therapy, with corticosteroids used when there is concurrent constrictive pericarditis. New diagnostic techniques have aided the sampling and analysis of pericardial fluid and in determining its cause. Treatment of pericarditis comprises high-dose Non-Steroidal AntiInflammatory Drugs (NSAIDs) for uncomplicated cases, with doses tapered when symptoms have subsided and C-reactive protein level has normalized, typically over several weeks. Colchicine (often a 3-6-month course) is needed to both alleviate symptoms and decrease recurrences, while glucocorticoids and newer therapies with interleukin-1 blockers are reserved for recurrences and/or failures of prior therapies. Integrated use of new imaging methods facilitates more precise detection and better management of complications such as pericardial effusion or constriction. The diagnostic yield of extensive laboratory evaluation and pericardiocentesis remains low; hence, invasive procedures should be limited mostly to patients in whom a therapeutic intervention is needed. The majority of pericardial effusions can be safely drained with an echo-guided percutaneous technique. Pericardiectomy remains the definitive treatment for constrictive pericarditis and provides symptomatic relief in most cases. Importantly, differentiation of constrictive pericarditis from restrictive cardiomyopathy remains a clinical challenge, but is facilitated by tissue Doppler and colour M-mode echocardiography. All these issues are reviewed herein.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postprandial Triglycerides and Residual Cardiovascular Risk: Rethinking Lipid-Lowering Strategies.","authors":"Ksenija Zecevic Crvenko, Vukasin Stojanovic, Emir Muzurović","doi":"10.2174/0115701611514979260706055757","DOIUrl":"https://doi.org/10.2174/0115701611514979260706055757","url":null,"abstract":"","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Treatment with Renin-Angiotensin System Inhibitors at Hospital Admission is Associated with Improved Reperfusion and Mortality Among STEMI Patients Undergoing Mechanical Reperfusion: Insight from the ISACS-STEMI COVID-19 Registry.","authors":"Giuseppe De Luca, Magdy Algowhary, Berat Uguz, Dinaldo Oliveira, Vladimir Ganyukov, Zan Zimbakov, Miha Cercek, Lisette Okkels Jensen, Poay Huan Loh, Lucian Calmac, Gerard Roura I Ferrer, Alexander Quadros, Marek Malewski, Fortunato Scotto Di Uccio, Clemens Von Birgelen, Francesco Versaci, Jurrien Ten Berg, Gianni Casella, Aaron Wong Sung Lung, Petr Kala, Jose Luis Díez Gil, Xavier Carrillo, Maurits Dirksen, Victor Manuel Becerra-Munoz, Michael Kang-Yin Lee, Dafsah Arifa Juzar, Rodrigo de Moura Joaquim, Roberto Paladino, Davor Milicic, Periklis Davlouros, Nikola Bakraceski, Filippo Zilio, Luca Donazzan, Adriaan Kraaijeveld, Gennaro Galasso, Arpad Lux, Lucia Marinucci, Vincenzo Guiducci, Maurizio Menichelli, Alessandra Scoccia, Aylin Hatice Yamac, Kadir Ugur Mert, Xacobe Flores Rios, Tomas Kovarnik, Michal Kidawa, Jose Moreu, Vincent Flavien, Enrico Fabris, Inigo Lozano Martínez-Luengas, Francisco Bosa Ojeda, Carlos Arellano-Serrano, Gianluca Caiazzo, Giuseppe Cirrincione, Hsien-Li Kao, Juan Sanchis Forés, Luigi Vignali, Hélder Pereira, Stephane Manzo-Silbermann, Santiago Ordonez, Alev Arat Ozkan, Bruno Scheller, Heidi Lehtola, Rui Teles, Christos Mantis, Antti Ylitalo, João António Brum Silveira, Ivan Bessonov, Rodrigo Zoni, Stefano Savonitto, George Kochiadakis, Dimitrios Alexopoulos, Carlos Uribe, John Kanakakis, Benjamin Faurie, Gabriele Gabrielli, Alejandro Gutierrez Barrios, Juan Pablo Bachini, Alex Rocha, Frankie Chor-Cheung Tam, Alfredo Rodriguez, Antonia Anna Lukito, Anne Bellemain-Appaix, Gustavo Pessah, Giuliana Cortese, Guido Parodi, Mohammed Abed Burgadha, Elvin Kedhi, Pablo Lamelas, Harry Suryapranata, Matteo Nardin, Monica Verdoia","doi":"10.2174/0115701611415264260622061654","DOIUrl":"https://doi.org/10.2174/0115701611415264260622061654","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the large use of renin-angiotensin system inhibitors (RASI) in STSegment Elevation Myocardial Infarction (STEMI) patients, few data have been reported on the prognostic impact of chronic RASI at admission in patients suffering from STEMI, especially during the COVID-19 pandemic. Therefore, the current study investigated the prognostic impact of chronic RASI at admission in patients suffering from STEMI, including both SARS-CoV-2 positive and negative individuals, enrolled before and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We included STEMI patients who received primary percutaneous coronary intervention (PPCI) and were enrolled in the ISACS-STEMI COVID-19 registry. In the present sub-analysis, patients were allocated according to chronic RASI therapy at admission. The primary study endpoint was the occurrence of in-hospital mortality. Secondary endpoints were postprocedural TIMI 3 flow and mortality at 1 month.</p><p><strong>Results: </strong>The overall population was 15,693 patients, including 6,213 patients pretreated with RASI. Several differences in baseline characteristics were observed between the two groups. No difference was observed in the prevalence of SARS-CoV-2 infection. After correction for all baseline confounders, including procedural features, chronic pretreatment with RASI was independently associated with improved postprocedural TIMI 3 flow (OR [95% CI] = 1.14 [1.03-1.35], p = 0.042), lower in-hospital mortality (adjusted OR [95% CI] = 0.64 [0.54-0.75], p < 0.001), and lower 30-day mortality (adjusted OR [95% CI] = 0.62 [0.53-0.73], p < 0.001).</p><p><strong>Conclusion: </strong>This is the largest study investigating the prognostic impact and benefits of chronic RASI pre-treatment in STEMI patients undergoing PPCI, including those treated during the COVID19 pandemic. We found that chronic RASI treatment at hospital admission was associated with significant improvement in reperfusion and reduction in mortality, without any negative effect in SARS-CoV-2 positive patients. Results should be interpreted considering the retrospective, nonrandomized nature of the study.</p>","PeriodicalId":11278,"journal":{"name":"Current vascular pharmacology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}