European Heart Journal Supplements最新文献_第2页

How much does eliminating one or two cardiovascular risk factors matter?: Evidence from the Global Cardiovascular Risk Consortium. 消除一两个心血管危险因素有多重要？：来自全球心血管风险联盟的证据。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag047

Roberto Spoladore, Stefano Pedroli, Andrea Tacchetto, Paolo Verdecchia, Stefano Savonitto

{"title":"How much does eliminating one or two cardiovascular risk factors matter?: Evidence from the Global Cardiovascular Risk Consortium.","authors":"Roberto Spoladore, Stefano Pedroli, Andrea Tacchetto, Paolo Verdecchia, Stefano Savonitto","doi":"10.1093/eurheartjsupp/suag047","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag047","url":null,"abstract":"Five modifiable cardiovascular risk factors-hypertension, diabetes, smoking, hypercholesterolemia, and obesity-account for approximately 50% of the global burden of cardiovascular disease. Recent data from the Global Cardiovascular Risk Consortium show that the absence of diabetes and smoking is associated with the lowest risk in terms of life expectancy and years lived free from cardiovascular disease. A systolic blood pressure below 130 mmHg, lower non-HDL cholesterol levels, and normal body weight are associated with a later onset of cardiovascular disease and a more modest increase in life expectancy. The absence of hypertension is correlated with the greatest number of years lived free from cardiovascular events. Smoking is confirmed as one of the most influential risk factors in terms of its impact on health and longevity. Individuals who eliminate hypertension and smoking in midlife gain the greatest number of additional years of life free from cardiovascular disease and all-cause mortality, respectively. Male sex emerges as a traditional, non-modifiable risk factor independent of modifiable risk factors. Finally, even the absence of all the risk factors considered remains associated with a residual lifetime probability of developing cardiovascular disease.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v148-v153"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacological therapy in the obese patient: is it only a matter of fat loss? 肥胖患者的药物治疗：仅仅是减脂的问题吗？

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag029

Claudio Borghi, Alessio Bragagni

{"title":"Pharmacological therapy in the obese patient: is it only a matter of fat loss?","authors":"Claudio Borghi, Alessio Bragagni","doi":"10.1093/eurheartjsupp/suag029","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag029","url":null,"abstract":"Obesity is a chronic, multifactorial condition strongly associated with increased cardiovascular and metabolic risk, as well as the development of systemic complications. Recent evidence from randomized controlled trials-including SELECT, STEP-HFpEF, STEP-HFpEF DM, SUMMIT, and SURMOUNT-5-has demonstrated the effectiveness of glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 agonists in the treatment of obesity, with clinical benefits that appear to extend beyond weight reduction alone. In addition to substantial reductions in fat mass, these agents improve cardiovascular parameters (including reductions in major adverse cardiovascular events), functional capacity, and quality of life. Additional benefits have been observed at the metabolic level, with reductions in glycated haemoglobin, blood pressure, triglycerides, and systemic inflammatory markers such as high-sensitivity C-reactive protein. These results confirm that pharmacological modulation of the incretin axis should not be viewed merely as an adjunctive strategy for weight loss, but rather as an integrated therapeutic intervention capable of modifying overall cardiovascular risk and improving the inflammatory and metabolic profile of the obese patient. In light of these findings, a re-evaluation of the role of pharmacological therapy in the clinical management paradigm of obesity is warranted.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v43-v47"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

When to prefer MitraClip over cardiac surgery. 什么时候选择MitraClip而不是心脏手术。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag036

Fausto Castriota, Angelo Squeri, Roberto Nerla

{"title":"When to prefer MitraClip over cardiac surgery.","authors":"Fausto Castriota, Angelo Squeri, Roberto Nerla","doi":"10.1093/eurheartjsupp/suag036","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag036","url":null,"abstract":"Severe mitral regurgitation (MR) is associated with an unfavourable prognosis, characterized by high mortality and reduced quality of life. Mitral surgery remains the gold standard for degenerative MR in patients with low operative risk, ensuring durability and improved survival; however, in elderly or frail patients, perioperative risk limits the applicability of surgical treatment. In this context, transcatheter edge-to-edge repair (TEER), predominantly with MitraClip™, has assumed an increasingly important role. The 2025 ESC/EACTS Guidelines recommend TEER in patients with severe secondary MR who remain symptomatic despite optimized medical therapy and cardiac resynchronization, with evidence demonstrating reduced hospitalizations and improved quality of life. Randomized trials such as COAPT and RESHAPE-HF2 have consolidated these findings, while the MATTERHORN study has shown non-inferiority of TEER compared with surgery in terms of clinical efficacy, with a superior safety profile. In primary MR, ongoing studies (REPAIR-MR, MITRA-HR) are evaluating the effectiveness of TEER vs. surgery in patients at moderate or high surgical risk. In summary, MitraClip currently represents the preferred therapeutic option in patients with high-risk secondary MR, while surgery remains indicated for repairable primary MR in low-risk surgical candidates.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v77-v81"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early discontinuation of acetylsalicylic acid after angioplasty in acute coronary syndromes: the NEO-MINDSET and TARGET-FIRST studies. 急性冠状动脉综合征血管成形术后早期停用乙酰水杨酸：NEO-MINDSET和TARGET-FIRST研究。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag027

Giacinto Di Leo, Diego Nastasi, Davide Capodanno

{"title":"Early discontinuation of acetylsalicylic acid after angioplasty in acute coronary syndromes: the NEO-MINDSET and TARGET-FIRST studies.","authors":"Giacinto Di Leo, Diego Nastasi, Davide Capodanno","doi":"10.1093/eurheartjsupp/suag027","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag027","url":null,"abstract":"Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 receptor inhibitor (P2Y12i) for 12 months represents the standard of care after acute coronary syndrome (ACS). However, balancing ischaemic protection against bleeding risk remains challenging, providing the rationale for the development of de-escalation strategies. European and U.S. guidelines allow shortening the duration of DAPT in patients at high bleeding risk, whilst still maintaining 12 months as the reference recommendation. Interest in abbreviated DAPT regimens has been driven by improvements in percutaneous coronary intervention devices and techniques, as well as by a better understanding of the temporal evolution of ischaemic and bleeding risks. Several trials have shown that short-duration DAPT followed by monotherapy-particularly with a P2Y12i-is not inferior in terms of ischaemic outcomes and significantly reduces bleeding events. In this context, the NEO-MINDSET trial failed to demonstrate the non-inferiority of immediate P2Y12i monotherapy compared with standard DAPT. In contrast, the TARGET-FIRST study confirmed the safety of ASA discontinuation after 30 days in selected patients, with a clear bleeding benefit. Overall, the available evidence indicates that immediate discontinuation of ASA in patients with acute coronary syndrome is not universally safe, whereas strategies based on at least 1 month of DAPT followed by monotherapy with a potent P2Y12i currently represent the most balanced approach for selected patients. More refined personalization of antiplatelet therapy, guided by an integrated assessment of ischaemic and bleeding risks, represents the future perspective in this field.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v62-v67"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Percutaneous coronary intervention or conservative therapy for chronic total coronary occlusions (CTOs)? Evidence from the ISCHEMIA trial. 慢性冠状动脉全闭塞（CTOs）经皮冠脉介入治疗还是保守治疗？缺血试验的证据。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag033

Cristina Madaudo, Giuseppe Vadalà, Giuseppe Astuti, Alfredo Ruggero Galassi

{"title":"Percutaneous coronary intervention or conservative therapy for chronic total coronary occlusions (CTOs)? Evidence from the ISCHEMIA trial.","authors":"Cristina Madaudo, Giuseppe Vadalà, Giuseppe Astuti, Alfredo Ruggero Galassi","doi":"10.1093/eurheartjsupp/suag033","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag033","url":null,"abstract":"The management of chronic total coronary occlusions (CTOs) remains one of the most debated areas in interventional cardiology because of its technical complexity and the relatively high risk of procedural complications. Although the effectiveness of percutaneous coronary intervention for CTOs (CTO-PCI) in improving symptoms has been demonstrated, its impact on hard clinical outcomes remains controversial. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA Trial) and the ISCHEMIA CTO sub-study provide important insights: in patients with stable coronary artery disease and moderate-to-severe ischaemia, an initial invasive strategy does not reduce cardiovascular mortality or myocardial infarction compared with optimized medical therapy. However, the trial was not designed to specifically assess the effectiveness of CTO-PCI, and only a minority of enrolled patients had a CTO, which was revascularized in only few cases. In addition, the ISCHEMIA trial excluded high-risk patients who are frequently encountered in everyday clinical practice, such as those with left main coronary artery disease, severe symptoms, or recent acute coronary syndromes. This article critically analyses the results of the ISCHEMIA Trial in the context of CTOs, comparing them with evidence from dedicated CTO-PCI studies, and proposes an integrated decision-making model based on symptom control, objective demonstration of inducible ischaemia and myocardial viability, multimodal imaging, and discussion within the Heart Team.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v106-v110"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Therapy of amyloidosis: stabilizers and silencers. 淀粉样变性的治疗：稳定剂和消声器。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag034

Alberto Aimo, Vincenzo Castiglione, Luna Latorre, Giorgia Panichella, Giuseppe Vergaro, Michele Emdin

{"title":"Therapy of amyloidosis: stabilizers and silencers.","authors":"Alberto Aimo, Vincenzo Castiglione, Luna Latorre, Giorgia Panichella, Giuseppe Vergaro, Michele Emdin","doi":"10.1093/eurheartjsupp/suag034","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag034","url":null,"abstract":"Transthyretin amyloidosis (ATTR) is a systemic disease characterized by the deposition of misfolded transthyretin (TTR) fibrils. It most commonly presents as cardiomyopathy (ATTR-CM), particularly in elderly patients with the wild-type form, whereas hereditary variants may manifest with polyneuropathy (ATTRv-PN) and/or cardiac involvement. The widespread adoption of non-invasive diagnostic pathways has increased disease recognition and facilitated the early initiation of disease-modifying therapies. Stabilizers limit dissociation of the TTR tetramer and the formation of new amyloid fibrils. Tafamidis demonstrated a benefit on mortality and cardiovascular hospitalizations in the ATTR-ACT trial and remains the treatment supported by the most robust evidence, with greater efficacy when initiated at earlier disease stages. Acoramidis, a next-generation stabilizer, improved a hierarchical composite end-point in the ATTRibute-CM trial and has been approved for ATTR-CM treatment, too. Gene-silencing therapies (small interfering RNA and antisense oligonucleotides) reduce hepatic TTR synthesis and circulating protein levels. Patisiran is approved for ATTRv-PN and, in the APOLLO-B trial, showed a functional benefit in ATTR-CM, although it has not been approved for this indication in the United States. Vutrisiran, a subcutaneously administered siRNA given every 12 weeks, reduced mortality and recurrent cardiovascular events in the HELIOS-B trial and has been approved for ATTR-CM treatment. This review summarizes the rationale and principal clinical evidence supporting tetramer stabilizers and gene-silencing therapies, which are now central to the management of ATTR-CM.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v100-v105"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New cardiovascular risk factor and clinical surrogate: epicardial fat. 新的心血管危险因素及临床替代物：心外膜脂肪。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag043

Saima Mushtaq, Maria Elisabetta Mancini, Riccardo Maragna, Ettore Ventura, Gianluca Pontone

{"title":"New cardiovascular risk factor and clinical surrogate: epicardial fat.","authors":"Saima Mushtaq, Maria Elisabetta Mancini, Riccardo Maragna, Ettore Ventura, Gianluca Pontone","doi":"10.1093/eurheartjsupp/suag043","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag043","url":null,"abstract":"Coronary computed tomography angiography (CCTA) has become a cornerstone in the non-invasive evaluation of coronary artery disease (CAD). Beyond defining stenosis severity, CCTA enables detailed quantification of total atherosclerotic burden, plaque composition, and imaging markers of plaque vulnerability. Recent advances-including artificial intelligence (AI)-enhanced algorithms-now allow automated and highly reproducible plaque phenotyping, with major implications for risk stratification and therapeutic monitoring. Concurrently, imaging of pericoronary adipose tissue has introduced novel biomarkers of vascular inflammation, particularly the Fat Attenuation Index and pericoronary adipose tissue attenuation. These indices independently predict adverse cardiovascular events beyond traditional risk factors. Serial imaging studies further demonstrate that lipid-lowering and anti-inflammatory therapies modulate plaque biology, promoting regression or stabilization. Integration of coronary plaque analytics, adipose tissue biology, and AI-driven risk prediction is redefining preventive cardiology and enabling increasingly individualized management strategies.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v139-v142"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Discontinuation of anticoagulation therapy after atrial fibrillation ablation: the ALONE-AF and OCEAN studies. 房颤消融后停止抗凝治疗：ALONE-AF和OCEAN研究。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag026

Mario Campisi, Florinda Bonanno, Piera Capranzano

{"title":"Discontinuation of anticoagulation therapy after atrial fibrillation ablation: the ALONE-AF and OCEAN studies.","authors":"Mario Campisi, Florinda Bonanno, Piera Capranzano","doi":"10.1093/eurheartjsupp/suag026","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag026","url":null,"abstract":"Two randomized trials, the ALONE-AF and OCEAN, have provided valuable evidence to guide the management of oral anticoagulation therapy after ablation of atrial fibrillation. In the ALONE-AF study, amongst patients with no documented atrial fibrillation recurrence at 1 year after transcatheter ablation, the 2-year incidence of the composite endpoint of stroke, systemic embolism, and major bleeding was significantly lower in those who discontinued oral anticoagulation compared with those who continued therapy. This difference was driven by a reduction in major bleeding events, with similar rates of stroke between groups. In the OCEAN study, amongst patients without atrial fibrillation (AF) recurrence during the year following transcatheter ablation, rivaroxaban 15 mg, compared with acetylsalicylic acid (ASA), did not significantly reduce the 3-year incidence of stroke, systemic embolism, or new silent embolic cerebral infarction, but was associated with an increased risk of clinically relevant non-major bleeding. The annualized incidence of thromboembolic events was low (0.3-0.6 events per 100 patient-years). Taken together, data from these two trials suggest that discontinuation of oral anticoagulation (OAC) may be a clinically reasonable option in patients without AF recurrence for at least 1 year after ablation. This strategy should be limited to patients at low thromboembolic risk, comparable to those enrolled in the two trials. Furthermore, the implementation of optimal and sustainable rhythmmonitoring strategies is essential to support decisions regarding OAC discontinuation after AF ablation.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v73-v76"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coronary artery anomalies: contemporary approaches to risk stratification and management. 冠状动脉异常：危险分层和管理的当代方法。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag021

Flavio Giuseppe Biccirè, Dario Mafrica, Matteo Mancinelli, Felicia Rozza, Barbara Dell'Elmo, Laura Gatto, Francesco Prati

{"title":"Coronary artery anomalies: contemporary approaches to risk stratification and management.","authors":"Flavio Giuseppe Biccirè, Dario Mafrica, Matteo Mancinelli, Felicia Rozza, Barbara Dell'Elmo, Laura Gatto, Francesco Prati","doi":"10.1093/eurheartjsupp/suag021","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag021","url":null,"abstract":"The widespread adoption of coronary computed tomography angiography (CCTA) has led to a growing detection of coronary artery anomalies in contemporary clinical practice, often as incidental findings during the evaluation of suspected or known coronary artery disease. Among these, anomalous aortic origin of a coronary artery (AAOCA) represents the most clinically debated entity, historically associated with myocardial ischaemia and sudden cardiac death, yet increasingly identified in asymptomatic or minimally symptomatic adults. Accumulating evidence indicates that most AAOCA diagnosed in adulthood are not associated with functionally relevant ischaemia and frequently follow a benign clinical course, highlighting the limitations of anatomy-based risk stratification alone. In this context, CCTA plays a pivotal role by accurately defining coronary origin and course, characterizing proximal vessel morphology, and assessing concomitant atherosclerotic disease, which often represents the predominant determinant of symptoms and prognosis in adult patients. Recent studies have demonstrated that quantitative CCTA-derived parameters can reliably exclude hemodynamically significant AAOCA and reduce unnecessary downstream testing. In selected cases, invasive functional assessment and intracoronary imaging provide incremental value by clarifying the presence and mechanisms of ischaemia but should be reserved for carefully selected patients. This review summarizes current evidence on coronary artery anomalies with a specific focus on AAOCA and proposes a pragmatic, stepwise approach integrating anatomical and functional assessment to guide clinical decision-making in daily practice.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v27-v31"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

When anticoagulant therapy is not enough: recurrent stroke. 抗凝治疗无效时：复发性中风。

IF 1.7 4区医学

European Heart Journal Supplements Pub Date : 2026-03-11 eCollection Date: 2026-05-01 DOI: 10.1093/eurheartjsupp/suag052

Filippo Stazi

{"title":"When anticoagulant therapy is not enough: recurrent stroke.","authors":"Filippo Stazi","doi":"10.1093/eurheartjsupp/suag052","DOIUrl":"https://doi.org/10.1093/eurheartjsupp/suag052","url":null,"abstract":"Despite the use of oral anticoagulants, the residual risk of recurrent ischaemic stroke in patients with atrial fibrillation (AF) is ∼4% per year; however, in patients who experience a stroke despite oral anticoagulant therapy (OAT), this risk approaches 9% per year. It is therefore essential to identify patients at higher risk and to develop new strategies for secondary prevention. These strategies include the exclusion of non-AF-related causes, optimization of OAT and its early initiation after stroke, as well as an aggressive rhythm-control approach. Additional non-pharmacological options include surgical or percutaneous left atrial appendage occlusion, although its effectiveness in secondary prevention after ischaemic stroke is still under evaluation. Novel pharmacological therapies targeting factors XI and XIa are currently under investigation and may provide comparable efficacy with improved safety compared with direct oral anticoagulants. Conversely, switching from one anticoagulant to another or adding antiplatelet therapy is completely ineffective. The mechanisms underlying recurrent stroke despite anticoagulant therapy are therefore complex, making an individualized, patient-specific approach mandatory.","PeriodicalId":11956,"journal":{"name":"European Heart Journal Supplements","volume":"28 Suppl 5","pages":"v164-v168"},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0