European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Postoperative atrial fibrillation and stroke after non-cardiac surgery: a systematic review and meta-analysis.","authors":"Jacopo Donati, Doralisa Morrone, Freek Verheugt, Raffaele De Caterina","doi":"10.1093/ehjcvp/pvaf056","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf056","url":null,"abstract":"<p><strong>Background: </strong>Postoperative atrial fibrillation (POAF) is common after non-cardiac surgery. Because often transient, there are uncertainties on the associated risk of stroke, possibly driving the need for long-term anticoagulation.</p><p><strong>Methods: </strong>We performed a systematic PubMed search until January 16th, 2025, related to the incidence of stroke in patients with POAF after non-cardiac surgery. We included papers reporting outcomes, excluding studies only dealing with epidemiology, mechanisms, management and treatment. We excluded studies reporting on POAF after cardiac surgery. Risk of bias was assessed for each study, and the certainty of evidence was evaluated using the GRADE methodology.</p><p><strong>Results: </strong>We retrieved and included 40 studies (including review papers) for the systematic review. These were then further selected to create a final list of 19 studies included in the meta-analysis. The reported incidence of stroke after POAF was found to be widely variable, ranging between 0.4% and 16.7% at 1 year. Stroke incidence also varies widely according to the type of surgery and patient characteristics. With only three exceptions, all studies, however, reported a risk of stroke higher in the POAF group than in the no-POAF group, with a mean Odds Ratio (OR) of 3.02.</p><p><strong>Conclusions: </strong>POAF on average triples the risk of stroke, with variations related to patient characteristics and type of surgery. Patients after non-cardiac surgery should be monitored at least during hospitalization to detect POAF. Future studies are necessary to evaluate optimal duration and modalities of monitoring, as well as to assess the relevance of symptomatic vs asymptomatic AF episodes.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early DAPT Discontinuation After Acute Myocardial Infarction: Finding the Optimal TARGET.","authors":"Nikolaos Pyrpyris, Kyriakos Dimitriadis, Paolo Calabrò, Felice Gragnano","doi":"10.1093/ehjcvp/pvaf075","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf075","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ranolazine in patients with chronic coronary syndromes: real-world data provide new evidence on the antiarrhythmic properties of the drug.","authors":"Stefano Fumagalli, Melania Dovizio, Stefania Mazzoni, Luca Degli Esposti, Emanuele Santamaria, Giulia Spanalatte, Carlo Fumagalli, Camilla Cagnoni, Arianna Tariello, Elisabetta Cerbai, Niccolò Marchionni","doi":"10.1093/ehjcvp/pvaf074","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf074","url":null,"abstract":"<p><strong>Aims: </strong>Ranolazine (Ran) is an anti-anginal drug inhibiting late sodium current, an action possibly hindering arrhythmias onset. Indeed, some evidence supports the anti-arrhythmic effects of Ran. The aim of this study, which evaluated Italian patients with chronic coronary syndrome (CCS), was to investigate whether Ran, as an add-on therapy, was associated with a lower incidence of atrial fibrillation (AF) compared to no Ran prescription (No-Ran).</p><p><strong>Methods and results: </strong>The original population (N=6.1 million) derived from the databases of the Italian National Health System; information concerned hospitalizations with the related diagnoses, drug therapy, follow-up clinical events and visits. Patients hospitalized between 2011 and 2020 for any cause and discharged with an ICD-9-CM CCS code were studied if AF had not been diagnosed before. The follow-up duration was 4.4 and 5.0 years for the Ran and the No-Ran cohorts, respectively.Study subjects were 171,015 (mean age: 72 years; men: 66%; Ran: N=22,207; No-Ran: N=148,808). After propensity score matching, Ran (N=6,384) and No-Ran (N=25,536) cohorts were similar for age, sex, comorbidities and drug therapy. AF incidence during follow-up was 5.3% and 9.6% in the Ran and in the No-Ran cohorts, respectively, with a 41% drug-related lower risk of arrhythmia development in the Cox model (HR=0.59, 95%CI: 0.53-0.67, p<0.001). Also, Ran correlated with reduced incidence of brady-arrhythmias (p=0.001) and ventricular tachy-arrhythmias (p=0.049), and with lower mortality (p<0.001).</p><p><strong>Conclusion: </strong>Our study, performed in a subset of the Italian CCS population, showed that Ran therapy was safe and associated with a long-term reduced AF incidence.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: sex-related variations in platelet reactivity.","authors":"Mattia Galli, Dominick J Angiolillo, Fabio M Pulcinelli","doi":"10.1093/ehjcvp/pvaf054","DOIUrl":"10.1093/ehjcvp/pvaf054","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"520-521"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When More Is Worse: Aspirin Backfires in Anticoagulated Post-PCI Patients.","authors":"Felice Gragnano, Mattia Galli, Paolo Calabrò, Erik L Grove","doi":"10.1093/ehjcvp/pvaf071","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf071","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences in platelet aggregation: rebuttal to reply.","authors":"Marco Cattaneo","doi":"10.1093/ehjcvp/pvaf059","DOIUrl":"10.1093/ehjcvp/pvaf059","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"522-523"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related variations in platelet reactivity in presence or absence of antiplatelet therapy.","authors":"Mattia Galli, Sergio Terracina, Eleonora Schiera, Simone De Corci, Diego Sangiorgi, Massimo Mancone, Luigi Frati, Sebastiano Sciarretta, Dominick J Angiolillo, Fabio M Pulcinelli","doi":"10.1093/ehjcvp/pvaf034","DOIUrl":"10.1093/ehjcvp/pvaf034","url":null,"abstract":"<p><strong>Aims: </strong>Emerging evidence suggests sex-specific differences in platelet biology and clinical responses to antiplatelet agents. Light transmission aggregometry (LTA) represents the historical gold standard for the assessment of platelet reactivity but is influenced by pre-analytical and analytical variables. We analysed a large dataset of patients undergoing LTA using a standardized methodology to investigate the impact of sex on platelet reactivity with or without antiplatelet therapy.</p><p><strong>Methods and results: </strong>Between 2004 and 2022, 11,913 patients sequentially underwent LTA assessments following stimulation with adenosine diphosphate (ADP) (2 µM), collagen (2 µg/mL), arachidonic acid (AA, 0.5 mM), and epinephrine (10 µM). After applying study entry criteria, 5687 patients were included: 428 healthy volunteers (HV, F = 273; M = 155), 1055 controls (CTR; F = 725; M = 330), 3289 aspirin-treated patients (ASA; F = 2058; M = 1231), 430 clopidogrel-treated patients (CLOP; F = 272; M = 158), and 485 patients on dual antiplatelet therapy (DAPT; F = 166; M = 319). Within each group, results were analysed and compared between males and females.Females exhibited significantly greater platelet reactivity in response to ADP compared to males in the HV (P = 0.004), CTR (P < 0.0001), ASA (P < 0.0001), and CLOP (P < 0.018) groups, but not in the DAPT group. Among aspirin-treated patients, females showed increased platelet reactivity (P < 0.0001) in response to collagen, compared with males.</p><p><strong>Conclusion: </strong>Females exhibit heightened baseline ADP-dependent platelet reactivity and a diminished response to aspirin and clopidogrel monotherapy compared to males.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"509-517"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness and safety of dual antiplatelet therapy with ticagrelor vs. clopidogrel in older adults with acute coronary syndrome: a target trial emulation study.","authors":"Carole A Marxer, Paul Hjemdahl, Juan J Carrero, Edouard L Fu","doi":"10.1093/ehjcvp/pvaf035","DOIUrl":"10.1093/ehjcvp/pvaf035","url":null,"abstract":"<p><strong>Aims: </strong>There is conflicting trial evidence on the comparative effects of dual antiplatelet therapy (DAPT) with ticagrelor vs. clopidogrel in older patients with acute coronary syndromes (ACS). We aimed to assess the risk of major adverse cardiovascular events (MACE) and major bleeding in ACS patients ≥75 years initiating ticagrelor vs. clopidogrel treatment.</p><p><strong>Methods and results: </strong>We used healthcare data from the Stockholm region (2011-2021) to emulate a hypothetical target trial comparing ticagrelor vs. clopidogrel. MACE was defined as a composite of cardiovascular death, myocardial infarction, or stroke. Patients were followed for 12 months. Inverse probability of treatment weighting was used to adjust for 46 baseline confounders. We used weighted Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) and the weighted Aalen-Johansen estimator to estimate absolute risks (AR).Among 4637 older patients [median age, 81 years (IQR, 77-85)], 49% initiated DAPT with ticagrelor and 51% with clopidogrel. After weighting, all confounders were balanced. Ticagrelor was associated with a lower one-year MACE risk than clopidogrel (11.1% vs. 14.9%), corresponding to an AR difference of -3.8% (95%CI, -6.8, -0.8). The HR for ticagrelor vs. clopidogrel was 0.73 (95%CI, 0.56-0.95). There was no difference in the risk of major bleeding with one-year absolute risks of 4.3% with ticagrelor vs. 4.8% with clopidogrel, and a HR of 0.89 (95%CI, 0.63-1.27).</p><p><strong>Conclusion: </strong>In ACS patients aged ≥75 years, ticagrelor was associated with a lower risk of MACE than clopidogrel. There were no differences in major bleeding, although the confidence interval was wide.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"500-508"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes with the use of aspirin vs. clopidogrel as a combination therapy with direct oral anticoagulant after coronary stent implantation in patients with atrial fibrillation.","authors":"Soohyun Kim, Soyoon Park, Hwajung Kim, Nilar Aung, Sung-Hwan Kim, Kiyuk Chang, Young Choi","doi":"10.1093/ehjcvp/pvaf043","DOIUrl":"10.1093/ehjcvp/pvaf043","url":null,"abstract":"<p><strong>Aims: </strong>Patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) are recommended to receive double antithrombotic therapy including an antiplatelet agent and direct oral anticoagulants (DOAC). The efficacy and safety of aspirin vs. clopidogrel as a combination therapy with DOAC were compared in the present study.</p><p><strong>Methods and results: </strong>Patient data from the Korea National Health Insurance Service from 2013 to 2020 were analysed. A total of 9157 patients with AF who received double antithrombotic therapy consisting of an antiplatelet agent and a DOAC after PCI were included. Patients were classified into the clopidogrel or aspirin group and 1:1 propensity score (PS) matching was performed. The major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, myocardial infarction, ischaemic stroke, or systemic thromboembolism. After PS matching, the clopidogrel and aspirin groups consisted of 2882 patients each. During a median follow-up of 20.1 months, the incidence of MACE was not significantly different between the two groups (hazard ratio [HR] for clopidogrel group 0.91, 95% confidence interval [CI] 0.81-1.02). The incidence of ischaemic endpoints did not significantly differ between the two groups. A significant difference was not observed in the incidence of major bleeding events (HR 0.94, 95% CI 0.78-1.12) and net adverse clinical events (HR 0.93, 95% CI 0.84-1.03).</p><p><strong>Conclusion: </strong>In patients with AF receiving double antithrombotic therapy after PCI, aspirin and clopidogrel showed similar efficacy and safety when used in combination with DOAC.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"532-539"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-treatment with P2Y12 inhibitors in acute myocardial infarction with cardiogenic shock.","authors":"Anthony Elhadad, David Sulman, Niki Procopi, Perrine Devos, Frederic Beaupré, Nassim Braik, Louis Giovachini, Pierre Charleux, Alain Combes, Juliette Chommeloux, Patrick Ecollan, Stéphanie Rouanet, Mathieu Kerneis, Johanne Silvain, Gilles Montalescot, Michel Zeitouni","doi":"10.1093/ehjcvp/pvaf019","DOIUrl":"10.1093/ehjcvp/pvaf019","url":null,"abstract":"<p><strong>Background and aims: </strong>There are currently no data regarding pre-treatment with P2Y12 inhibitors in patients with acute myocardial infarction complicated with cardiogenic shock (AMI-CS). This study investigates the effectiveness and safety of pre-treatment with P2Y12 inhibitors in patients with AMI-CS.</p><p><strong>Methods and results: </strong>Using the ACTION-SHOCK cohort, we included consecutive patients hospitalized between 2012 and 2023 with AMI-CS admitted for coronary angiography within 24 h of admission. Pretreatment was defined by the administration before angiography of an oral loading dose of a P2Y12 inhibitor. We evaluated the association between pretreatment and either major adverse cardiovascular events (MACE) or major bleeding at 30 days after admission, using an inverse probability weighting (IPW) approach. MACE was defined by the composite of all-cause death, ischaemic stroke, myocardial infarction, or stent thrombosis. Major bleeding was defined by Bleeding Academic Research Consortium grade 3, 4, or 5. Among the 421 patients with AMI-CS admitted to the catheterization laboratory within 24 h of admission, 224 (53.2%) patients received pre-treatment with a P2Y12 inhibitor. No association between pre-treatment with P2Y12 inhibitor and MACE at 30 days was found [42.1% vs. 38.8%-IPW hazard ratio (wHR): 1.11, 95% CI: 0.82-1.50]. Pre-treatment was associated with an increased risk of major bleeding (42.2% vs. 32.3%-wHR: 1.48, 95% CI: 1.05-2.08). The effect of pre-treatment on MACE or major bleeding at 30 days is consistent across STEMI/NSTEMI patients.</p><p><strong>Conclusion: </strong>In patients with AMI-CS, pretreatment with a P2Y12 inhibitor oral load was associated with an increased risk of major bleeding without benefit on MACE.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"489-499"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}