International journal of cardiology最新文献

{"title":"Sex differences in coronary plaque burden: Implications for risk stratification","authors":"Ivan Lechner , Martin Reindl , Gudrun Feuchtner , Sebastian J. Reinstadler","doi":"10.1016/j.ijcard.2026.134155","DOIUrl":"10.1016/j.ijcard.2026.134155","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134155"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959255","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":"PCSK9 is a predictive biomarker of major adverse events after acute myocardial infarction","authors":"Ahmad Hayek ,&nbsp;Simon Leboube ,&nbsp;Camille Brun ,&nbsp;Florentin Moulin ,&nbsp;Julie Bastide ,&nbsp;Brahim Harbaoui ,&nbsp;Nathan Mewton ,&nbsp;Gabriel Bidaux ,&nbsp;Claire Crola Da Silva ,&nbsp;Thomas Bochaton","doi":"10.1016/j.ijcard.2026.134176","DOIUrl":"10.1016/j.ijcard.2026.134176","url":null,"abstract":"<div><h3>Background</h3><div>Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates low-density lipoprotein cholesterol (LDLc) metabolism and is implicated in vascular inflammation and plaque vulnerability. Its role following ST-elevation myocardial infarction (STEMI) remains under investigation.</div></div><div><h3>Objective</h3><div>To assess changes in PCSK9 plasma levels during hospitalization for STEMI and evaluate their association with major adverse cardiovascular events (MACE).</div></div><div><h3>Methods</h3><div>In this prospective, single-center study (2016–2021), 346 STEMI patients undergoing percutaneous coronary intervention (PCI) without prior PCSK9 inhibitor use were enrolled. PCSK9 levels were measured at admission and discharge using ELISA. Infarct size and left ventricular ejection fraction (LVEF) were evaluated by cardiac magnetic resonance imaging at one month. Clinical events were recorded over a 12-month follow-up.</div></div><div><h3>Results</h3><div>PCSK9 plasma levels increased significantly from admission to 48 h (median 321.4 pg/mL, IQR [266.1–377.3]). Higher 48 h PCSK9 levels (≥ Q2–Q4) were associated with increased MACE (HR 9.2, 95% CI 3.9–21.7, <em>p</em> = 0.008), including ischemic events (HR 3.8, CI 1.05–14.0). In multivariable analysis, elevated PCSK9 remained independently associated with MACE (adjusted HR 7.5, CI 1.02–54.8, <em>p</em> = 0.049).</div></div><div><h3>Conclusion</h3><div>PCSK9 levels rise post-STEMI and are independently associated with worse clinical outcomes. PCSK9 may serve as a prognostic biomarker and therapeutic target to reduce cardiovascular risk post-MI.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134176"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984731","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":"A step back in time, or a call to action? Revisiting cardiology-unit access in modern acute myocardial infarction treatment","authors":"Satoshi Honda,&nbsp;Teruo Noguchi","doi":"10.1016/j.ijcard.2025.134144","DOIUrl":"10.1016/j.ijcard.2025.134144","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134144"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915110","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":"Optical coherence tomography for early detection of cardiac allograft vasculopathy in pediatric heart recipients","authors":"Lisa-Maria Rosenthal ,&nbsp;Ezgi Yavasca ,&nbsp;Oliver Miera ,&nbsp;Annemarie Krauss ,&nbsp;Friederike Danne ,&nbsp;Stephan Schubert ,&nbsp;Felix Berger ,&nbsp;Peter Kramer","doi":"10.1016/j.ijcard.2025.134146","DOIUrl":"10.1016/j.ijcard.2025.134146","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure following pediatric heart transplantation (HT). Early detection could improve long-term outcomes, but conventional coronary angiography often misses early-stage disease. Optical coherence tomography (OCT), a high-resolution intravascular imaging modality, may enable earlier and more sensitive CAV detection.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed pediatric HT recipients who underwent OCT between 2012 and 2024. OCT-derived maximal intima thickness (MIT) and cross-sectional area ratios were correlated with coronary angiography findings, hemodynamic data, CAV risk factors, and immunosuppressive regimens. Longitudinal analysis was performed in patients with serial OCT.</div></div><div><h3>Results</h3><div>In 214 examinations (386 vessels) from 67 patients (median age 3.1 years, IQR 1.8–8.2, 49 % female, median 5.1 years post-HT, IQR 2.6–9.4), OCT-detected CAV (MIT ≥ 0.3 mm) was present in 31.9 % of vessels versus 8.0 % detected by angiography. MIT correlated with recipient and donor age, donor-recipient age difference, episodes of antibody-mediated rejection and was higher in adult donor grafts. Everolimus therapy was associated with significant lower MIT (<em>p</em> &lt; 0.001). Over time, 73 % of grafts showed OCT-CAV with earlier onset (<em>p</em> = 0.037) and higher incidence (<em>p</em> = 0.005) in vessels from adult donors. Presence of CAV by angiography or OCT was associated with increased graft loss or dysfunction (log rank <em>p</em> = 0.044, HR 4.21, 95 %CI 1.16–15.28).</div></div><div><h3>Conclusions</h3><div>OCT detects early-stage CAV in pediatric heart transplant recipients with substantially greater sensitivity than angiography. Everolimus may mitigate early CAV progression. OCT offers significant potential for early detection and risk stratification.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134146"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905613","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":"Cardiovascular disease related to influenza infection and the protective role of influenza vaccination","authors":"Massimo Volpe ,&nbsp;Allegra Battistoni ,&nbsp;Giovanni Gabutti ,&nbsp;Paolo Bonanni ,&nbsp;Giulio Nati ,&nbsp;Roberta Siliquini","doi":"10.1016/j.ijcard.2026.134178","DOIUrl":"10.1016/j.ijcard.2026.134178","url":null,"abstract":"<div><div>Influenza infection is a well-established trigger of severe respiratory and cardiovascular complications, particularly in older adults, frail individuals, and patients with underlying cardiovascular disease. Seasonal peaks are consistently associated with excess hospitalizations and mortality. Epidemiological studies have shown sharp increases in acute cardiac events during and immediately after influenza infection, including a high-rate of acute coronary syndromes and heart failure. The cardiovascular impact of influenza is mediated by multiple mechanisms. Systemic inflammation, plaque destabilization, metabolic imbalance, endothelial dysfunction, and pro-thrombotic activation collectively contribute to acute coronary syndromes, myocarditis, arrhythmias, and acute or worsening heart failure. These complications generate a substantial clinical and socioeconomic burden, particularly in elderly and high-risk individuals.</div><div>Despite the availability of effective and inexpensive vaccines, influenza vaccination remains underused in high-risk cardiovascular populations. Randomized trials and meta-analyses consistently support vaccination as a powerful preventive tool, associated with a 25–37% reduction in major adverse cardiovascular events and mortality, with benefits comparable to established cardioprotective therapies. Evidence is strongest in patients with coronary artery disease, ACS, diabetes, and in older adults, although results in heart failure populations remain more heterogeneous. Enhanced vaccines including adjuvanted, high-dose, and cell-based formulations offer superior protection in elderly and immunocompromised individuals and are increasingly recommended by national and international health authorities.</div><div>Given the robust evidence linking influenza to cardiovascular events and the proven protective role of vaccination, systematic implementation of tailored influenza immunization strategies in patients with CVD is essential to optimize preventive care.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134178"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975029","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":"Effect of percutaneous coronary intervention for chronic total occlusion on diastolic atrioventricular coupling in ST-elevation myocardial infarction patients","authors":"Casper F. Coerkamp ,&nbsp;Mark J. Hinderks ,&nbsp;Joëlle Elias ,&nbsp;Anna van Veelen ,&nbsp;Loes P.C. Hoebers ,&nbsp;Truls Råmunddal ,&nbsp;Peep Laanmets ,&nbsp;Erlend Eriksen ,&nbsp;René J. van der Schaaf ,&nbsp;Paul Knaapen ,&nbsp;Bimmer E.P.M. Claessen ,&nbsp;Alexander Hirsch ,&nbsp;Nick S. Nurmohamed ,&nbsp;Peter Damman ,&nbsp;Richard A.P. Takx ,&nbsp;R. Nils Planken ,&nbsp;José P.S. Henriques ,&nbsp;Robin Nijveldt","doi":"10.1016/j.ijcard.2026.134154","DOIUrl":"10.1016/j.ijcard.2026.134154","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) did not improve left ventricular systolic function. The left atrioventricular coupling index (LACI), derived from cardiovascular magnetic resonance (CMR), reflects diastolic atrioventricular coupling and has recently emerged as a parameter for diastolic dysfunction and a prognostic marker after acute myocardial infarction. We aimed to assess the impact of CTO PCI on LACI in patients with ST-elevation myocardial infarction (STEMI) and concurrent CTO</div></div><div><h3>Methods</h3><div>In this CMR substudy of the multicentre randomised controlled EXPLORE trial, 200 patients (mean age 60 ± 10 years, 88% male) underwent baseline CMR, and 178 patients had analysable 4-month follow-up CMR. LACI was defined as the ratio of left atrial and left ventricular end-diastolic volumes. The primary outcome was the effect of CTO PCI on LACI and change of LACI over time</div></div><div><h3>Results</h3><div>The significant improvement in LACI over time (Δ LACI – 1.0% [Q1-Q3: - 4.6 to 2.0], <em>P</em> = 0.005) was independent of CTO PCI or no-CTO PCI (<em>P</em> = 0.706). CTO PCI did not influence the change in LACI (− 0.8% [Q1-Q3: - 4.7 to 2.2], <em>P</em> = 0.122). Baseline LACI ≥20.6% was associated with an increased risk of all-cause death compared to LACI &lt;20.6% after multivariable adjustment (hazard ratio 2.37, 95% CI: 1.27 to 4.45, <em>P</em> = 0.007)</div></div><div><h3>Conclusions</h3><div>Among STEMI patients with a concurrent CTO, CTO PCI did not affect LACI at 4 months or its improvement over time. Elevated LACI early after STEMI independently predicted long-term all-cause mortality</div><div><strong>Clinical trial registration</strong>: The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial; NTR1108 <span><span>www.trialregister.nl</span><svg><path></path></svg></span>, Date registered NTR: 30-okt-2007.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134154"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948723","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":"Baseline clinical profile of patients with obstructive hypertrophic cardiomyopathy in the Italian Mavacamten early access program","authors":"G. Bonacchi ,&nbsp;A. Del Franco ,&nbsp;P. Agostoni ,&nbsp;E. Agricola ,&nbsp;E. Ammirati ,&nbsp;P. Baratta ,&nbsp;F. Barocelli ,&nbsp;E. Bertero ,&nbsp;E. Biagini ,&nbsp;G. Boriani ,&nbsp;P. Calabrò ,&nbsp;L. Calò ,&nbsp;C. Calore ,&nbsp;S. Carigi ,&nbsp;E. Carluccio ,&nbsp;N. Cerrato ,&nbsp;C. Chimenti ,&nbsp;A. Chinaglia ,&nbsp;C. Chiriatti ,&nbsp;L. Crotti ,&nbsp;I. Olivotto","doi":"10.1016/j.ijcard.2025.134152","DOIUrl":"10.1016/j.ijcard.2025.134152","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive hypertrophic cardiomyopathy (oHCM) has recently seen the introduction of mavacamten, a disease-specific therapy that alleviates obstruction and symptoms with potential effects on disease expression. Since most patients remain symptomatic with conventional therapies, mavacamten constitutes an efficacious treatment strategy</div></div><div><h3>Methods</h3><div>The early access program (EAP) for mavacamten treatment ran from September 2023 to September 2024. We collected clinical and echocardiographic data prospectively</div></div><div><h3>Results</h3><div>337 patients with oHCM (53% male, mean age 61.4 ± 12.3 years) were receiving mavacamten treatment from 54 centers in Italy. The EAP cohort was older and showed a more advanced cardiac phenotype, showing lower left ventricular ejection fraction (LVEF) (66 ± 6% vs 74 ± 6% in EXPLORER-HCM cohort, <em>p</em> &lt; 0.0001) and higher left atrial volume index (51.1 ± 16.4 ml/m² vs 40.5 ± 12.3 ml/m², <em>p</em> &lt; 0.0001. Only 74 (22%) patients in the EAP group were candidates for septal reduction therapy (SRT). Echocardiographic parameters like LVEF, maximal wall thickness and LAVI as well as pharmacologic therapy showed no difference between subgroups, while LVOT obstruction gradient was higher in SRT candidates (40 vs 63 mmHg, p &lt; 0.0001)..</div></div><div><h3>Conclusion</h3><div>The compassionate use program for mavacamten in Italy demonstrated significant engagement. The Italian oHCM cohort were older and exhibited more advanced disease stages compared to those in the EXPLORER-HCM trial. Only one-quarter of the patients were eligible for SRT, they did not show a more severe biomarker or echocardiographic parameters compared to those without indication. Mavacamten provides an additional option for oHCM patients unresponsive to standard therapy, especially those symptomatic but ineligible for SRT</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134152"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948705","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":"Prognostic significance of microvascular resistance reserve in chronic coronary syndrome","authors":"Peter Damman ,&nbsp;Tim P. van de Hoef","doi":"10.1016/j.ijcard.2026.134156","DOIUrl":"10.1016/j.ijcard.2026.134156","url":null,"abstract":"","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134156"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951737","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":"PREDICT - patient referral evaluation to determine indication for computed tomography to identify small aortic annulus size in patients with severe aortic stenosis","authors":"Sarosh Khan ,&nbsp;Abhinav Balasubramanian ,&nbsp;Benjamin Lim ,&nbsp;Ozan Demir ,&nbsp;Samer Fawaz ,&nbsp;Rohan Jagathesan ,&nbsp;Rajesh Aggarwal ,&nbsp;Swamy Gedela ,&nbsp;Alexia Farrugia ,&nbsp;Muhammad Mehmood ,&nbsp;Ibraheam Nabi ,&nbsp;Damandeep Singh Kharoud ,&nbsp;Arvind Singh ,&nbsp;Richard Jones ,&nbsp;John Davies ,&nbsp;Thomas Keeble ,&nbsp;Pierluigi Costanzo ,&nbsp;Christopher M Cook PhD","doi":"10.1016/j.ijcard.2026.134177","DOIUrl":"10.1016/j.ijcard.2026.134177","url":null,"abstract":"<div><h3>Background</h3><div>Mitigating prosthesis-patient mismatch (PPM) in surgical or transcatheter aortic valve replacement (SAVR/TAVR) requires early identification of small annulus size (SAS). While computed tomography (CT) is the gold-standard for annular sizing in TAVR, its routine use in SAVR planning is limited by resource constraints.</div></div><div><h3>Objectives</h3><div>To develop and validate the Patient Referral Evaluation to Determine Indication for CT (PREDICT) model - a predictive tool utilizing anthropometric and transthoracic echocardiography (TTE)-derived data to identify SAS at the point of referral.</div></div><div><h3>Methods</h3><div>This retrospective, multicentre study included 1708 patients with severe aortic stenosis undergoing CT for annular assessment. A development cohort (<em>n</em> = 912) was used to construct the PREDICT multivariate regression model incorporating left ventricular outflow tract diameter (LVOTd), height, and sex. PREDICT performance was evaluated in a separate validation cohort (<em>n</em> = 796) using R², Bland-Altman analysis, and receiver operating characteristic (ROC) curves. Diagnostic accuracy was assessed for small annulus (≤430mm²), very small annulus (VSAS≤400mm²), and extremely small annulus (ESAS≤370mm²).</div></div><div><h3>Results</h3><div>In the validation cohort, PREDICT demonstrated good-to-excellent predictive accuracy, with AUCs of 0.838, 0.849, and 0.858 for SAS, VSAS, and ESAS, respectively; outperforming height and LVOTd alone (<em>p</em> &lt; 0.001). Negative predictive values were consistently high, exceeding 88% across all annulus size thresholds, confirming PREDICT's excellent rule-out capability. Bland-Altman analysis showed good agreement with CT (mean bias -7 mm²). Diagnostic performance was unaffected by age or sex (<em>p</em> &gt; 0.40).</div></div><div><h3>Conclusions</h3><div>PREDICT is a simple, accurate, non-invasive tool for identifying SAS at referral-optimizing CT use and enabling earlier planning to reduce PPM in severe aortic stenosis patients.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134177"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984794","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":"Joint effects of pulse pressure and LVEF on 12-month mortality in acute coronary syndrome patients undergoing PCI","authors":"Yanshan De ,&nbsp;Yu Han ,&nbsp;Yuanyuan Song ,&nbsp;Xiuheng Zhang ,&nbsp;Shuo Wu ,&nbsp;Bailu Wang ,&nbsp;Shujian Wei ,&nbsp;Yuguo Chen","doi":"10.1016/j.ijcard.2026.134174","DOIUrl":"10.1016/j.ijcard.2026.134174","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate admission pulse pressure (PP) as an independent predictor of 12-month mortality in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), and to explore its joint effect with left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods</h3><div>This observational study analyzed 2213 consecutive ACS patients from the BIPass study who underwent PCI. Patients were stratified by LVEF (&gt;50% vs. ≤50%) and PP levels (≤ 40 mmHg, 40 &lt; PP ≤ 60 mmHg, 60 &lt; PP ≤ 80 mmHg, and &gt; 80 mmHg). Primary endpoint was cardiac death, secondary endpoint was 12-month all-cause death. Restricted cubic spline (RCS) and Cox models assessed PP-mortality associations after adjusting for confounders; PP-LVEF interaction was visualized via heatmap and 3D surface plot.</div></div><div><h3>Results</h3><div>During follow-up, 37 all-cause deaths (1.67%) and 22 cardiac deaths (0.99%) were recorded. RCS confirmed a U-shaped PP-12-month mortality association (lowest risk: 41–60 mmHg). Multivariable analysis showed low PP (≤ 40 mmHg; adjusted HR = 18.21, 95% CI:1.65–201.01, <em>P</em> = 0.018) and high PP (&gt; 80 mmHg; adjusted HR = 18.91, 95% CI:2.05–174.93, <em>P</em> = 0.010) independently predicted cardiac death. In LVEF ≤50% patients, extreme PP elevated cardiac death (<em>P</em> = 0.004) and all-cause death (<em>P</em> = 0.044); in LVEF &gt;50% patients, only high PP increased outcomes (cardiac death: <em>P</em> = 0.034; all-cause death: <em>P</em> = 0.028), with low PP showing no significance.</div></div><div><h3>Conclusions</h3><div>Admission PP has a U-shaped association with 12-month mortality in post-PCI ACS patients. Reduced LVEF amplifies extreme PP's adverse effects. Integrated PP-LVEF assessment enhances risk stratification and guides personalized management.</div></div>","PeriodicalId":13710,"journal":{"name":"International journal of cardiology","volume":"448 ","pages":"Article 134174"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989101","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}