European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease: 10-year outcome from the DANAMI-3-PRIMULTI trial.","authors":"Yan Zhou, Burcu Tas Özbek, Jasmine Melissa Marquard, Utsho Islam, Lars Nepper-Christensen, Kiril Aleksov Ahtarovski, Dan Eik Høfsten, Ashkan Eftekhari, Kasper Kyhl, Christoffer Göransson, Lars Køber, Lene Holmvang, Frants Pedersen, Henning Kelbæk, Niels Vejlstrup, Jacob Thomsen Lønborg, Thomas Engstrøm","doi":"10.1093/ehjacc/zuag112","DOIUrl":"https://doi.org/10.1093/ehjacc/zuag112","url":null,"abstract":"<p><strong>Aims: </strong>The benefit of complete revascularization after primary percutaneous coronary intervention (PCI) is well established in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, but the long-term effect in older patients remains uncertain. We aimed to evaluate the 10-year outcome of complete revascularization in older patients (aged ≥75 years) compared with younger patients.</p><p><strong>Methods and results: </strong>Patients with STEMI and multivessel disease were randomized to either culprit-only or fractional flow reserve-guided complete revascularization in the DANAMI-3-PRIMULTI trial. This long-term sub-study stratified the included 627 patients by <75 years (517) and ≥75 years (110). The primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization occurring during a median follow-up of 10.5 years. Of the older patients, 50 underwent complete and 60 culprit-only revascularization, and of the younger patients, 264 were completely revascularized compared to 253 who had culprit-only PCI performed.In the older group, complete revascularization showed no association with the primary outcome (adjusted hazard ratio [HR] 1.29, 95% confidence interval [CI]: 0.82-2.03, P = 0.27). In contrast, complete revascularization was associated with a lower risk of the primary outcome (adjusted HR 0.68, 95% CI: 0.53-0.88, P = 0.003) in younger patients, primarily driven by a reduction in any revascularization (adjusted HR 0.60, 95% CI: 0.44-0.83, P = 0.002.</p><p><strong>Conclusion: </strong>In patients aged ≥75 years, clear evidence of a long-term (10 years) benefit of complete revascularization was not demonstrated. However, the elderly subgroup was small with limited events, and the finding should be interpreted as inconclusive. In contrast, complete revascularization was associated with a 32% lower risk of adverse outcomes among younger patients, primarily driven by a reduction in repeat revascularization, without evidence of reduced all-cause death or recurrent myocardial infarction.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873079","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":"Influences of socioeconomic and environmental factors on STEMI incidence and related mortality: Insights from the Belgian Environmental Myocardial Infarction Risk (EMIR) Study.","authors":"Tom De Potter, Christel Faes, Andreea Motoc, Els Verachtert, Bianca Cox, Hans Hooyberghs, Nikos Deligiannis, Esther Rodrigo Bonet, Diederik De Cock, Frans Fierens, Tim Nawrot, Steven Droogmans, Bernard Cosyns, Marc J Claeys, Jean-François Argacha","doi":"10.1093/ehjacc/zuag118","DOIUrl":"https://doi.org/10.1093/ehjacc/zuag118","url":null,"abstract":"<p><strong>Background: </strong>Current risk models for myocardial infarction incidence and post-event mortality primarily rely on clinical parameters and do not account for environmental or socioeconomic factors. We aimed to provide a more comprehensive assessment of determinants of ST-elevation myocardial infarction (STEMI) admission and in-hospital mortality.</p><p><strong>Methods: </strong>We analyzed nine years of national hospital discharge data of all STEMI admissions in Belgium (2012-2014, 2016-2021). Acute and chronic exposures to PM2.5, NO2, O3, temperature, noise, and greenspace were estimated at residential addresses using high-resolution models. Individual socioeconomic data were linked from administrative records. A time-stratified case-crossover design assessed associations between short-term air pollution exposures and STEMI admission, including delayed associations. Multivariable logistic regression examined clinical, socioeconomic, and environmental determinants of in-hospital mortality.</p><p><strong>Results: </strong>A total of 51,544 STEMI admissions were identified (51.4 per 100,000 inhabitants/year). Interquartile range increases in PM2.5 and NO2 were associated with higher same-day STEMI admission risk (PM2.5: OR 1.022, 95%CI 1.008-1.035; NO2: OR 1.044, 95%CI 1.025-1.063). O3 showed associations over delayed exposure windows (strongest at lag 0-2: OR 1.063, 95% CI 1.034-1.090). In-hospital mortality was 11.8% and was most strongly associated with socioeconomic factors, including lower individual and area-level income and retirement status, alongside clinical characteristics.</p><p><strong>Conclusions: </strong>Environmental factors through air pollution are associated with STEMI incidence, whereas socioeconomic factors such as financial precarity are related to in-hospital mortality. New risk models integrating socioeconomic and environmental vulnerabilities are needed to ensure an early recognition and reinforced care for patients at risk of adverse outcomes.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873038","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":"From arterial pressure to tissue perfusion: blood-pressure targets after resuscitated infarction-related cardiac arrest.","authors":"Alberto Calabrese, Daniel De Backer, Filippo Annoni","doi":"10.1093/ehjacc/zuag097","DOIUrl":"10.1093/ehjacc/zuag097","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"594-595"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577579","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":"Reply to 'letter to the editor: to stent, shock, or stand-by?: post-partum spontaneous coronary artery dissection with ventricular fibrillation'.","authors":"Bharath Raj Kidambi, Sai Krishna Seemala, Sean Gilhooley, Solomon Bienstock, Bhavanadhar Penta","doi":"10.1093/ehjacc/zuag068","DOIUrl":"10.1093/ehjacc/zuag068","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"628-629"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948082","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":"Acute heart failure diagnosis and vasodilator use in a nationwide registry study.","authors":"Jasmin Dam Lukoschewitz, Lucas Malta Westergaard, Johannes Grand","doi":"10.1093/ehjacc/zuag078","DOIUrl":"10.1093/ehjacc/zuag078","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"630"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197792","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":"Acute heart failure diagnosis and vasodilator use in a nationwide registry study: reply.","authors":"George Frederick Mkoma, Anders Hviid, Björn Pasternak, Henrik Svanström","doi":"10.1093/ehjacc/zuag079","DOIUrl":"10.1093/ehjacc/zuag079","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"631"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204461","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":"Landiolol for rate control in decompensated heart failure due to atrial fibrillation: the LARISA trial.","authors":"Marek Sramko, Ales Benak, Jakub Toman, Martin Kleissner, Michal Pazdernik, Josef Kautzner","doi":"10.1093/ehjacc/zuag027","DOIUrl":"10.1093/ehjacc/zuag027","url":null,"abstract":"<p><strong>Aims: </strong>Rate control of atrial fibrillation (AF) in acute heart failure (AHF) with reduced left ventricular ejection fraction (LVEF) is challenging. We evaluated the safety and efficacy of intensive rate control (IRC) using landiolol with adjunctive digoxin.</p><p><strong>Methods and results: </strong>Forty patients with AHF due to AF [heart rate (HR) > 130/min, LVEF <40%] were randomized to IRC with landiolol plus digoxin or standard rate control therapy. The primary endpoint was sustained HR reduction >20% or <115/min at 2 h. Haemodynamics, dyspnoea, and lung congestion were assessed serially. HR control was achieved faster in the IRC vs. standard group (median 1.5 vs. 4 h; P = 0.016). At 2 h, HR decreased by 40% of the IRC group vs. 23% of standard therapy group (P = 0.045), and the primary endpoint was reached in 80% vs. 20% of the patients, respectively (P = 0.04). IRC resulted in greater dyspnoea relief and lung decongestion without excess hypotension or adverse events. At 24 h, outcomes between the groups were similar.</p><p><strong>Conclusion: </strong>In AHF with reduced LVEF, protocolized landiolol-based intensive rate control provides faster and safe HR reduction with early symptomatic benefit compared with standard therapy. Pre-registered Clinical Trial Number:  ClinicalTrials.org: NCT04694092.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"622-626"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316927","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":"Biodegradable polymer sirolimus-eluting or durable polymer zotarolimus-eluting stents in high bleeding-risk patients with acute coronary syndrome: the BIOFLOW-DAPT randomized trial.","authors":"Nader Mankerious, Rayyan Hemetsberger, Adrian Wlodarczak, Béla Merkely, Henning Kelbæk, Guillaume Cayla, Jacek Legutko, Stefano Galli, Matthieu Godin, Gabor G Toth, Thibault Lhermusier, Mohammed Saad, Benjamin Honton, Francesca Sanguineti, Peter Laurenz Dietrich, Derk Frank, Francis Stammen, Bert Ferdinande, Johanne Silvain, Davide Capodanno, Holger Nef, Gert Richardt, Ralph Toelg, Marco Valgimigli","doi":"10.1093/ehjacc/zuag089","DOIUrl":"10.1093/ehjacc/zuag089","url":null,"abstract":"<p><strong>Aims: </strong>Patients at high bleeding risk (HBR) and acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are at high risk of adverse outcomes. We investigated the clinical outcomes and their consistency after biodegradable polymer sirolimus-eluting (BP-SES) or durable polymer zotarolimus-eluting stent (DP-ZES) implantation in HBR patients with or without ACS.</p><p><strong>Methods and results: </strong>The per-protocol population of the BIOFLOW-DAPT randomized control trial (RCT) consisted of HBR patients with (n = 541) or without ACS (n = 1245) who were randomized to BP-SES or DP-ZES and underwent 1 month dual antiplatelet therapy (DAPT). The primary efficacy and safety endpoints were target lesion failure (TLF), defined as the composite endpoint of cardiac death, target vessel myocardial infarction (TV-MI), or clinically driven target lesion revascularization (cd-TLR) as well as major bleeding defined as BARC 3 or 5 (according to Bleeding Academic Research Consortium classification) and definite/probable stent thrombosis (ST). At 1 year, patients with ACS suffered from higher cardiac death rates (3.4 vs. 1.3%, log-rank P = 0.004) but similar TLF (6.8 vs. 6.7%, P = 0.992), TV-MI (2.8 vs. 4.5%, P = 0.100), cd-TLR (1.4 vs. 2.1%, P = 0.300), major bleeding (4.2 vs. 3.1%, P = 0.266), and ST (0.2 vs. 0.9%, P = 0.098) compared with no ACS patients. The rate of TLF and of all secondary endpoints was consistent with BP-SES or DP-ZES across ACS strata.</p><p><strong>Conclusion: </strong>HBR patients with ACS are at higher risk of cardiac death than those without ACS and experience a consistent outcome with BP-SES or DP-ZES followed by 1 month DAPT at 1 year follow-up.</p><p><strong>Clinical trial registration: </strong>NCT04137510.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"596-607"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677532","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":"Beyond trial design: how a new global generation of trialists is shaping the future of cardiogenic shock research.","authors":"Hannah Schaubroeck, Tharusan Thevathasan, Rebecca Mathew, Helle Søholm, Janine Pöss, Alexandre Mebazaa","doi":"10.1093/ehjacc/zuag091","DOIUrl":"10.1093/ehjacc/zuag091","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"653-655"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359926","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":"Die kunst des Fortschritts liegt darin, Ordnung inmitten des Wandels zu bewahren: 'the art of progress lies in preserving order amid change'.","authors":"Pascal Vranckx, David Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuag085","DOIUrl":"10.1093/ehjacc/zuag085","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"581-583"},"PeriodicalIF":7.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663681","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}