European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Single vs. dual antiplatelet therapy in patients with severe peripheral arterial disease undergoing transcatheter aortic valve implantation: insights from the Hostile registry.","authors":"Mattia Galli, Roberto Nerla, Fausto Castriota, Francesco Saia, Won-Keun Kim, Alessandro Iadanza, Ole De Backer, Francesco Burzotta, Nicolas M Van Mieghem, Thomas Pilgrim, Giuseppe Musumeci, Max M Meertens, Michael Joner, Francesco Meucci, Stefan Toggweiler, Luca Testa, Sergio Berti, Matteo Montorfano, Daniel Braun, Marco De Carlo, Marco Barbanti, Giulio Stefanini, Georg Nickenig, Tommaso Piva, Azeem Latib, Italo Porto, Ran Kornowski, Antonio L Bartorelli, Mohamed Abdel-Wahab, Tullio Palmerini","doi":"10.1093/ehjcvp/pvaf049","DOIUrl":"10.1093/ehjcvp/pvaf049","url":null,"abstract":"<p><strong>Aims: </strong>Single antiplatelet therapy (SAPT) has been shown to be a safer alternative to dual antiplatelet therapy (DAPT) in patients without atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI). However, antithrombotic therapy for TAVI patients with severe peripheral artery disease (PAD) remains an underexplored area. This study aimed to evaluate and compare the outcomes of SAPT and DAPT in this high-risk patient population.</p><p><strong>Methods and results: </strong>The HOSTILE registry was a multicentre, international, observational study including 1707 consecutive patients with hostile femoral access undergoing TAVI in 28 international centres. Among 573 patients without AF treated through transfemoral or non-thoracic alternative approach, 144 received SAPT and 429 DAPT after TAVI. The primary efficacy endpoint was the propensity-adjusted rate of major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, stroke, or transient ischaemic attack. The primary safety endpoint was the propensity-adjusted rate of major bleeding. Outcomes were reported at 30 days and 12 months. Dual antiplatelet therapy was associated with a non-significant reduction in MACE at 30 days [hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.25-2.18; P = 0.59] and at 12 months (HR 0.89, 95% CI 0.35-2.24; P = 0.80) compared with SAPT, but with a significant interaction between antiplatelet strategy and PAD severity (P = 0.01), suggesting a greater benefit of DAPT in patients with a high PAD severity. Dual antiplatelet therapy was associated with reduced all-cause death at 12 months (HR 0.22, 95% CI 0.10-0.47; P < 0.001) but not at 30 days (HR 0.26, 95% CI 0.05-1.22; P = 0.09) compared with SAPT. There was no difference in major bleeding at 30 days (P = 0.13) or 12 months (P = 0.10) between groups. There were no differences between groups in any bleeding at 30 days (P = 0.16) or 12 months (P = 0.17).</p><p><strong>Conclusion: </strong>In TAVI patients with severe PAD, DAPT was associated with a trend towards improved outcomes compared with SAPT, particularly in those with higher PAD severity. These findings, including the observed reduction in 1-year mortality with DAPT, warrant further investigation in prospective studies.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"524-531"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636597","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 differences in platelet aggregation.","authors":"Marco Cattaneo","doi":"10.1093/ehjcvp/pvaf052","DOIUrl":"10.1093/ehjcvp/pvaf052","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"518-519"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648893","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":"Antiplatelet treatment in different clinical settings.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvaf060","DOIUrl":"10.1093/ehjcvp/pvaf060","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"487-488"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947649","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":"The role of cangrelor in acute and high-risk PCI settings.","authors":"Uwe Zeymer, Tobias Geisler, Dirk Westermann, Kurt Huber","doi":"10.1093/ehjcvp/pvaf042","DOIUrl":"10.1093/ehjcvp/pvaf042","url":null,"abstract":"<p><p>Dual antiplatelet therapy with acetylsalicylic acid (ASA) and an oral P2Y12 inhibitor is the standard of care to prevent thrombotic complications in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). However, the oral administration of P2Y12 inhibitors bears significant limitations in acute and high-risk PCIs, particularly in ST-elevation myocardial infarction (STEMI) patients, especially those presenting with cardiogenic shock (CS) and cardiac arrest (CA). In these cases, factors such as active vomiting, altered physiology, sedatives, mechanical ventilation, and therapeutic hypothermia can impair drug absorption, reducing the intended antiplatelet effect and increasing ischaemic risk. In these cases, intravenous antiplatelet strategies with ASA and cangrelor could guarantee adequate periprocedural platelet inhibition. Here, we discuss the role of cangrelor in acute and high-risk PCI settings. The pharmacokinetic and pharmacodynamic attributes of cangrelor are discussed first, underscoring the distinctive features that make cangrelor an attractive antiplatelet agent in acute PCI settings. The second part of the review summarizes the evidence from real-world studies that illustrate how cangrelor has been adopted in contemporary practice. Finally, we provide a practical guide to cangrelor use, including recommendations for transitioning from cangrelor to oral P2Y12 inhibitors after PCI.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"540-551"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224805","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 features modifying the cardiovascular benefits of GLP-1 receptor agonists: a systematic review and meta-analysis.","authors":"Arzu Kalayci, James Louis Januzzi, Makiko Mitsunami, Ibrahim Halil Tanboga, Can Yucel Karabay, Charles Michael Gibson","doi":"10.1093/ehjcvp/pvaf037","DOIUrl":"10.1093/ehjcvp/pvaf037","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes (T2D), but heterogeneity exists across cardiovascular outcome trials (CVOTs). A comprehensive search of PubMed, EMBASE, and Cochrane Library was conducted through November 2024. Eligible CVOTs compared GLP-1 RAs with placebo in T2D patients. The primary outcome was MACE, defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using I², τ², and R². Meta-regression analyses evaluated the influence of baseline covariates on cardiovascular benefits of GLP-1 RAs, contingent upon the detection of moderate to substantial heterogeneity (I² ≥ 30%). Sensitivity analyses and GRADE assessments were also performed. Ten trials (67 769 patients; 34 536 receiving GLP-1 RAs) were analyzed. GLP-1 RAs significantly reduced MACE compared with placebo (OR = 0.87, 95% CI: 0.81-0.93, P < 0.001, I² = 48.4%). Cardiovascular death (OR = 0.86, 95% CI: 0.79-0.94, P < 0.001, I² = 22.6%) and all-cause mortality (OR = 0.87, 95% CI: 0.82-0.94, P < 0.001, I² = 17.7%) were also reduced. Meta-regression revealed a greater cardiovascular benefit in patients with higher baseline body mass index (BMI; logOR = -0.098 per kg/m², P = 0.006, R² = 99.98%) and older age (logOR = -0.033 per year, P = 0.023, R² = 75.47%). Sensitivity analyses confirmed the robustness of these findings, with consistent effect sizes and no single trial unduly influencing the results. The certainty of evidence was rated as high for all outcomes based on GRADE criteria. GLP-1 RAs significantly reduce MACE, cardiovascular death, and all-cause mortality in T2D patients. Higher baseline BMI and older age were associated with greater cardiovascular benefit.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"552-561"},"PeriodicalIF":6.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947589","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":"Seeking for the Boundaries of De-escalation in Antiplatelet Therapy for Acute Coronary Syndromes.","authors":"Mattia Galli, Felice Gragnano, Marco Valgimigli","doi":"10.1093/ehjcvp/pvaf070","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf070","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091424","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":"Authors' reply to: \"Preventing Atrial Fibrillation with SGLT2 Inhibitors: Time, Sex, and Substrate\" by Karakasis et al.","authors":"Damiano Fedele, Sara Amicone, Lisa Canton, Francesco Angeli, Matteo Armillotta, Luca Bergamaschi, Carmine Pizzi","doi":"10.1093/ehjcvp/pvaf072","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf072","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091450","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":"Witnessing a Possible Revolution in Antiplatelet Therapy for Coronary Artery Bypass Grafting.","authors":"Mattia Galli, Felice Gragnano, Mario Gaudino","doi":"10.1093/ehjcvp/pvaf068","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf068","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085514","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":"An Old Drug in a New Era: Digitoxin in the Spotlight After DIGIT-HF.","authors":"Felice Gragnano, Mattia Galli, Paolo Calabrò, Dobromir Dobrev","doi":"10.1093/ehjcvp/pvaf069","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf069","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085490","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":"Diuretic strategies in acute heart failure: a systematic review and network meta-analysis of randomized clinical trials.","authors":"A Cannatà, G Anastasia, V De Marzo, O Caspi, D Bromage, I Porto, G Savarese, T McDonagh, Z L Cox, P Ameri","doi":"10.1093/ehjcvp/pvaf067","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf067","url":null,"abstract":"<p><strong>Aims: </strong>Several diuretic strategies, including furosemide iv boluses (FB) or continuous infusion (FC), are used in acute heart failure (AHF).</p><p><strong>Methods and results: </strong>We systematically searched phase 3 randomized clinical trials (RCTs) evaluating diuretic regimens in admitted AHF patients within 48 hours and irrespective of clinical stabilization. We calculated the odds ratio (OR) of FC or FB plus another diuretic (sequential nephron blockade, SNB) compared to FB alone on 24-hour weight loss (WL) and worsening renal function (WRF), with a random-effects model with inverse variance weighting. Urine output, hypokalaemia, hyponatremia, and all-cause mortality/rehospitalization were secondary endpoints.In 25 selected RCTs (7,149 patients, mean age 68.9±8.7 years, mean LVEF 38.2±10.7%), FC (OR 1.55 [95% confidence interval 1.39-1.63], FB plus tolvaptan (OR 1.57 [1.39-1.77]), FB plus SGLT2i (OR 1.23 [1.06-1.42]), and FB plus thiazide (OR 1.63 [1.37-1.94]) were associated with greater WL than FB. FB plus SGLT2i (OR 1.52 [1.19-1.94]) and FB plus acetazolamide (OR 1.81 [1.31-2.49]) were associated with WRF. FB plus thiazide was associated with both WRF (OR 1.78 [1.43-2.21]) and hypokalaemia (OR 1.69 [1.32-2.16]). Results were consistent in sensitivity analyses considering urine output, RCTs protocol-established furosemide doses, or daily furosemide dose. Congestion/decongestion scores and clinical outcomes were reported in around 50% of RCTs. In an underpowered exploratory analysis, mortality/rehospitalization was non-significantly lower with SGLT2i (OR 0.45 [0.19-1.07]).</p><p><strong>Conclusions: </strong>FC and SNB improve surrogates of response to FB in AHF. SNB is also connoted by WRF and may induce hypokalaemia. The endpoints of diuretic RCTs should be revised and harmonized.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033039","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}