Journal of cardiology最新文献

{"title":"Polymer-free sirolimus- and probucol-eluting stents versus durable polymer-based everolimus-eluting stents for percutaneous coronary revascularization: A prospective multicenter randomized clinical trial.","authors":"Akihiro Ikuta, Junji Yajima, Shinya Okazaki, Taishi Yonetsu, Jiro Ando, Itaru Takamisawa, Yoshiaki Ito, Shigeru Saito, Masami Sakurada, Yukihiko Yoshida, Yukio Ozaki, Tetsuya Amano, Kenshi Fujii, Junya Shite, Koh Ono, Shigeru Nakamura, Tomofumi Takaya, Atsushi Hirohata, Koichi Kishi, Kenji Ando, Tomohiro Kawasaki, Yoshisato Shibata, Ken Kozuma, Yuji Ikari, Takafumi Ueno, Toshiya Muramatsu, Kiyoshi Hibi, Yoshihiro Morino, Kazushige Kadota","doi":"10.1016/j.jjcc.2025.01.018","DOIUrl":"10.1016/j.jjcc.2025.01.018","url":null,"abstract":"<p><strong>Background: </strong>Owing to the advent of new generation drug-eluting stents, percutaneous coronary intervention (PCI) outcomes are improving. However, the polymers, which have been the most common type of coatings used in drug-eluting stents, have some issues. The study aim was to evaluate the clinical outcomes of patients undergoing PCI with polymer-free sirolimus- and probucol-eluting stents (NP023).</p><p><strong>Methods: </strong>This clinical trial was a prospective multicenter single-blind noninferiority randomized study performed at 22 hospitals in Japan. We randomly assigned patients in a 2:1 ratio to undergo PCI with either NP023 or durable polymer-based everolimus-eluting stents (control stents) with a 5-year follow-up. The primary outcome was freedom from target lesion failure (TLF) at 9 months, defined as patient-oriented composite of cardiac death, ischemia-driven target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization. The secondary outcome included adverse outcomes at 5 years following the index procedure.</p><p><strong>Results: </strong>Overall, 432 patients (463 lesions) were treated at 22 sites in Japan [mean age, 68 years; males, 345 (80 %); chronic coronary artery diseases, 322 (74.5 %)]. Of the participants, 91 % completed the 5-year follow-up. The Kaplan-Meier estimates of the percentages of patients who were free from TLF were 95.8 % and 97.3 % with NP023 and control stents, respectively (hazard ratio, 0.98; 95 % confidential interval, 0.80-1.21; p < 0.01 for noninferiority). At the 5-year follow-up, the secondary endpoint for safety was not different between the two groups.</p><p><strong>Conclusions: </strong>The results of this study showed similar outcomes for polymer-free sirolimus- and probucol-eluting stents and durable polymer-based everolimus-eluting stents regarding freedom from TLF at 9 months and other outcomes at 5 years among patients undergoing PCI.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of American Heart Association's Life's Essential 8 and mortality among US adults with and without cardiovascular disease.","authors":"Ofer Kobo, Gurleen Kaur, Jacqueline E Tamis-Holland, Sarah Zaman, Renée P Bullock-Palmer, Kamala Tamirisa, Martha Gulati, Mamas A Mamas","doi":"10.1016/j.jjcc.2025.01.015","DOIUrl":"10.1016/j.jjcc.2025.01.015","url":null,"abstract":"<p><strong>Background: </strong>Differences in the American Heart Association's Life's Essential 8 (LE8) score and its association with mortality based on the presence of clinically prevalent cardiovascular disease (CVD) has not been assessed previously.</p><p><strong>Methods: </strong>Data from the National Health and Nutrition Examination Survey 2009-2018 were utilized to calculate LE8 scores among adult patients, stratified by the presence of existing CVD. Health metrics were further divided into health behaviors and health factors. Scores were also evaluated based on sex, age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of cardiovascular health (CVH), estimated using LE8 score, and risk of all-cause and cardiovascular mortality.</p><p><strong>Results: </strong>25,359 patients were included in the analysis, of which 10.2 % had CVD. Individuals with known CVD had lower overall CVH (55.9 vs. 65.8, p < 0.001), health behaviors (60.6 vs. 67.9, p < 0.001), and health factors (51.3 vs. 63.8, p < 0.001) scores. The lower CVH scores in those with prior CVD persisted after stratification by sex, age, race/ethnicity, and socioeconomic status. When assessing the association of CVH metrics with mortality, for every 10-point increase in LE8 score, there was a significant reduction (17 %-27 %) in all-cause and CV mortality in those with and without CVD.</p><p><strong>Conclusions: </strong>Individuals with known CVD have lower CVH metric scores. Overall, the LE8 score is able to predict future CV outcomes in both individuals with and without CVD and highlights the importance of effective implementation strategies that target health factors and behaviors in primary and secondary prevention populations.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of inspiratory muscle training in improving clinical outcomes in heart failure patients: An updated systematic review and meta-analysis.","authors":"Ahmed Kamal Siddiqi, Maryam Shahzad, Akash Kumar, Manahil Ahmed, Lakshmi Sridharan, Mahmoud H Abdou, Muhammad Naeem","doi":"10.1016/j.jjcc.2025.01.016","DOIUrl":"10.1016/j.jjcc.2025.01.016","url":null,"abstract":"<p><strong>Background: </strong>Inspiratory muscle training (IMT) has shown improvements in clinical variables for heart failure (HF) patients. We conducted a meta-analysis to investigate if IMT can enhance respiratory muscle strength, quality of life (QoL), and reduce cardiac biomarker levels in HF patients.</p><p><strong>Methods: </strong>PubMed, Cochrane Library, and Google Scholar databases were systematically searched up to July 8, 2024. Randomized controlled trials of IMT in HF patients were included. A random effects model was used to calculate weighted mean differences (WMDs) and 95 % confidence intervals. Outcomes analyzed included minute ventilation to carbon dioxide output slope (VE/VCO2), QoL, six-minute walk distance (6MWD), maximum expiratory pressure, maximum inspiratory pressure (MIP), N-terminal pro B-type natriuretic peptide (NT-pro-BNP), forced vital capacity, forced expiratory volume in one second, and metabolic equivalents.</p><p><strong>Results: </strong>Seventeen studies involving 510 patients (252 in IMT group, 258 in control) were included. IMT significantly improved 6MWD [WMD: 72.72; 95 % CI: (16.65 to 128.78); p = 0.01], QoL [WMD: -15.27; 95 % CI: (-21.01 to -9.53); p < 0.00001], VE/VCO2 [WMD: -5.09; 95 % CI: (-7.36 to -2.83); p < 0.0001], MIP [WMD: 13.77; 95 % CI: (7.51 to 20.03); p < 0.0001], and NT-pro-BNP levels [WMD: -659.66; 95 % CI: (-1212.87 to -106.46); p = 0.02].</p><p><strong>Conclusion: </strong>IMT significantly improved respiratory muscle strength, QoL, and reduced cardiac biomarker levels in patients with both heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. These findings suggest that IMT may be a promising exercise-based strategy for treating HF.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial structural remodeling and atrial fibrillation substrate: A histopathological perspective","authors":"Takanori Yamaguchi MD, PhD","doi":"10.1016/j.jjcc.2024.05.007","DOIUrl":"10.1016/j.jjcc.2024.05.007","url":null,"abstract":"<div><div>Atrial fibrillation (AF) substrate progresses with the advancement of atrial structural remodeling, resulting in AF perpetuation and recurrence. Although fibrosis is considered a hallmark of atrial structural remodeling, the histological background has not been fully elucidated because obtaining atrial specimens is difficult, especially in patients not undergoing open-heart surgery. Bipolar voltage reduction evaluated using electroanatomic mapping during AF ablation is considered a surrogate marker for the progression of structural remodeling; however, histological validation is lacking. We developed an intracardiac echocardiography-guided endomyocardial atrial biopsy technique to evaluate atrial structural remodeling in patients undergoing catheter ablation for nonvalvular AF. The histological factors associated with a decrease in bipolar voltage were interstitial fibrosis, as well as an increase in myocardial intercellular space preceding fibrosis, myofibrillar loss, and a decrease in cardiomyocyte nuclear density, which is a surrogate marker for cardiomyocyte density. Cardiomyocyte hypertrophy is closely associated with a decrease in cardiomyocyte nuclear density, suggesting that hypertrophic changes compensate for cardiomyocyte loss. Electron microscopy also revealed that increased intercellular spaces indicated the leakage of plasma components owing to increased vascular permeability. Additionally, amyloid deposition was observed in 4 % of biopsy cases. Only increased intercellular space and interstitial fibrosis were significantly higher for long-standing persistent AF than for paroxysmal AF and associated with recurrence after AF ablation, suggesting that this interstitial remodeling is the AF substrate. An increase in intercellular space that occurs early in AF formation is a therapeutic target for the AF substrate, which prevents irreversible interstitial degeneration due to collagen accumulation. This endomyocardial atrial biopsy technique will allow the collection of atrial tissue from a wide variety of patients and significantly facilitate the elucidation of the mechanisms of atrial cardiomyopathy, structural remodeling, and AF substrates.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 47-55"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of prehospital electrocardiogram on door-to-device time in ST-segment elevation myocardial infarction with cardiogenic shock: Data from the Kanagawa Acute Cardiovascular Registry","authors":"Jin Kirigaya MD, PhD ,&nbsp;Yasushi Matsuzawa MDs, PhD ,&nbsp;Toshiaki Ebina MD, PhD ,&nbsp;Takeru Abe PhD ,&nbsp;Noriaki Iwahashi MD, PhD, FJCC ,&nbsp;Kazuki Fukui MD, PhD ,&nbsp;Atsuo Maeda MD, PhD, FJCC ,&nbsp;Yoshihiro Akashi MD, PhD, FJCC ,&nbsp;Junya Ako MD, PhD, FJCC ,&nbsp;Yuji Ikari MD, PhD, FJCC ,&nbsp;Atsuo Namiki MD, PhD ,&nbsp;Ichiro Michishita MD, PhD, FJCC ,&nbsp;Teruyasu Sugano MD, PhD ,&nbsp;Kouichi Tamura MD, PhD, FJCC ,&nbsp;Kiyoshi Hibi MD, PhD, FJCC ,&nbsp;Kazuo Kimura MD, PhD, FJCC ,&nbsp;Hiroshi Suzuki MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.08.004","DOIUrl":"10.1016/j.jjcc.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI.</div></div><div><h3>Methods</h3><div>This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (−) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups.</div></div><div><h3>Results</h3><div>The patient backgrounds of the PH-ECG (+) and PH-ECG (−) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (−) group [2756 (1292–6009) IU/ml vs. 2270 (957–5258) IU/ml, <em>p</em> = 0.048]. The FMC-to-door time was similar between the two groups [25 (20−33) min vs. 27 (20–35) min, <em>p</em> = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52–103) min vs. 83 (62–111) min, <em>p</em> = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, <em>p</em> = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time &lt; 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24–2.83), <em>p</em> = 0.003].</div></div><div><h3>Conclusions</h3><div>PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 108-114"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does previous valve replacement affect short-term coronary artery bypass grafting outcomes? A population-based National Inpatient Sample study from 2015 to 2020","authors":"Renxi Li BS ,&nbsp;Stephen J. Huddleston MD, PhD ,&nbsp;Deyanira J. Prastein MD","doi":"10.1016/j.jjcc.2024.08.005","DOIUrl":"10.1016/j.jjcc.2024.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease (CAD) and valvular disease frequently coexist due to similar pathophysiology. Effort has been dedicated to comprehending the outcomes of concomitant coronary revascularization and valve replacement procedures. However, the understanding of how prior valve replacement affects the outcomes of coronary artery bypass grafting (CABG) remains limited. Thus, this study aimed to conduct a population-based examination of the in-hospital outcomes in patients with previous valve replacement in CABG.</div></div><div><h3>Methods</h3><div>Patients who underwent CABG were identified in the National Inpatient Sample in the USA from Q4 2015–2020. Patients with age &lt; 18 years and concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between patients with and without previous valve replacement. In-hospital postoperative outcomes were assessed.</div></div><div><h3>Results</h3><div>There were 514 patients with previous valve replacement who underwent CABG, who were matched to 1588 out of 167,668 controls. After matching, patients with valve replacement had mostly comparable in-hospital outcomes except for a higher risk of vascular complications (1.75 % vs 0.57 %, <em>p</em> = 0.02), a longer length of stay (10.90 ± 7.04 days vs 9.95 ± 6.53 days, <em>p</em> = 0.01), and higher hospital charges (275,465 ± 229,088 US dollars vs 231,648 ± 189,938 US dollars, <em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>For short-term outcomes, CABG is generally safe for patients who have undergone previous valve replacement, although there is an increased risk of vascular complications that may warrant additional attention. The findings of this study can be valuable for preoperative risk assessment of patients who have had valve replacement and are considering CABG.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 96-97"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the lens: Unveiling the invisible atrioventricular node in the era of high-density mapping","authors":"Yuji Wakamatsu MD, PhD,&nbsp;Koichi Nagashima MD, PhD,&nbsp;Ryuta Watanabe MD, PhD,&nbsp;Shu Hirata MD,&nbsp;Moyuru Hirata MD,&nbsp;Yasuo Okumura MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.05.010","DOIUrl":"10.1016/j.jjcc.2024.05.010","url":null,"abstract":"<div><div><span><span>Numerous studies have clarified the histological characteristics of the area surrounding the atrioventricular (AV) node, commonly referred to as the triangle of Koch (ToK). Although it is suggested that the conduction of electric impulses from the atria to the ventricles via the AV node involves </span>myocytes<span> possessing distinct conduction properties and gap junction proteins, a comprehensive understanding of this complex conduction has not been fully established. Moreover, although various pathways have been proposed for both anterograde and retrograde conduction during </span></span>atrioventricular nodal reentrant tachycardia<span><span> (AVNRT), the reentrant circuits of AVNRT are not fully elucidated. Therefore, the slow pathway ablation for AVNRT has been conventionally performed, targeting both its anatomical location and slow pathway potential obtained during sinus rhythm<span>. Recently, advancements in high-density three-dimensional (3D) mapping systems have facilitated the acquisition of more detailed electrophysiological potentials within the ToK. Several studies have indicated that the activation pattern, the low-voltage area within the ToK obtained during sinus rhythm, and the fractionated potentials acquired during </span></span>tachycardia<span> may be optimal targets for slow pathway ablation. This review provides an overview of the tissue surrounding the AV node as reported to date and summarizes the current understanding of AV conduction and AVNRT circuits. Furthermore, we discuss recent findings on slow pathway ablation utilizing high-density 3D mapping systems, exploring strategies for optimal slow pathway ablation.</span></span></div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 56-62"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JCS/JCC/JSPCCS 2024 Guideline on Genetic Testing and Counseling in Cardiovascular Disease","authors":"Yasushi Imai,&nbsp;Kengo Kusano,&nbsp;Takeshi Aiba,&nbsp;Junya Ako,&nbsp;Yoshihiro Asano,&nbsp;Mariko Harada-Shiba,&nbsp;Masaharu Kataoka,&nbsp;Tomoki Kosho,&nbsp;Toru Kubo,&nbsp;Takayoshi Matsumura,&nbsp;Tetsuo Minamino,&nbsp;Kenji Minatoya,&nbsp;Hiroyuki Morita,&nbsp;Masakazu Nishigaki,&nbsp;Seitaro Nomura,&nbsp;Hitoshi Ogino,&nbsp;Seiko Ohno,&nbsp;Masayuki Takamura,&nbsp;Toshihiro Tanaka,&nbsp;Kenichi Tsujita,&nbsp;Katsushi Tokunaga","doi":"10.1016/j.jjcc.2024.10.002","DOIUrl":"10.1016/j.jjcc.2024.10.002","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 115-176"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal management of high bleeding risk patients undergoing percutaneous coronary interventions: Where do we stand?","authors":"Kyriakos Dimitriadis MD, PhD,&nbsp;Nikolaos Pyrpyris MD,&nbsp;Panagiotis Iliakis MD,&nbsp;Panagiotis Kanatas MD,&nbsp;Panagiotis Theofilis MD, PhD,&nbsp;Athanasios Sakalidis MD,&nbsp;Anastasios Apostolos MD,&nbsp;Panagiotis Tsioufis MD,&nbsp;Aggelos Papanikolaou MD,&nbsp;Konstantinos Aznaouridis MD, PhD,&nbsp;Konstantina Aggeli MD, PhD,&nbsp;Konstantinos Tsioufis MD, PhD","doi":"10.1016/j.jjcc.2024.08.002","DOIUrl":"10.1016/j.jjcc.2024.08.002","url":null,"abstract":"<div><div>Percutaneous coronary interventions (PCI) are the mainstay of treating obstructive coronary artery disease. However, procedural planning and individualization of the procedure is necessary for different patient phenotypes to optimize outcomes. Specifically, post-PCI pharmacotherapy with antiplatelets complicates the management of patients at high bleeding risk due to comorbidities, such as atrial fibrillation. Aiming to limit post-procedural adverse events and reduce the procedure-related bleeding risk, several novel technologies and hypotheses have been tested in clinical practice. Such frontiers include limiting the duration of dual antiplatelet therapy or even prescribing single regimens, using drug-coated balloons for performing the intervention and the effect of imaging-guided PCI in optimizing stent expansion. Furthermore, specific instruction in different patient phenotypes, such as atrial fibrillation and chronic kidney disease, are emerging, as despite both pathologies being considered at high bleeding risk, one size does not fit all. Thus, our review will provide all the recent updates on the field as well as algorithms and expert opinions on how to manage this, particularly common, phenotype of patient.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 79-87"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of door-to-balloon time and one-year outcomes in hospital survivors of ST-elevation myocardial infarction","authors":"Mitsuaki Sawano MD, PhD ,&nbsp;Shun Kohsaka MD, PhD ,&nbsp;Karthik Murugiah MBBS ,&nbsp;Hideki Ishii MD, PhD, FJCC ,&nbsp;Kyohei Yamaji MD, PhD ,&nbsp;Jun Takahashi MD, PhD, FJCC ,&nbsp;Kazuyuki Ozaki MD, PhD, FJCC ,&nbsp;Tetsuya Amano MD, PhD ,&nbsp;Ken Kozuma MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.06.009","DOIUrl":"10.1016/j.jjcc.2024.06.009","url":null,"abstract":"<div><div>In this study of 19,824 ST-elevated myocardial infarction (STEMI) patients from the J-PCI OUTCOME registry (January 1, 2017, to December 31, 2018), we investigated the association between door-to-balloon time (DTB) and 1-year post-discharge cardiovascular outcomes. Patients with DTB &gt;90 min were older and had higher comorbidities. The incidence of 1-year major adverse cardiovascular events (MACE) showed an incremental increase: 3.7 %, 4.8 %, and 7.7 % for DTB ≤60, DTB 60–90, and DTB &gt;90 groups, respectively. Adjusted hazard ratios (aHR) compared to the DTB 60–90 group were 0.83 (DTB ≤60, <em>p</em> = 0.03) and 1.25 (DTB &gt;90, <em>p</em><span><span> = 0.005). Subgroup analysis revealed higher risk for MACE in DTB &gt;90 group for patients aged &lt;70, men, no history of coronary revascularization, and those with cardiac arrest or </span>cardiogenic shock. Conversely, DTB ≤60 group without previous history had a lower MACE risk (aHR 0.80, </span><em>p</em><span> = 0.02). This study, the largest of its kind, demonstrates that a DTB below 90 min is associated with lower 1-year MACE risk, supporting current guidelines, and indicating additional benefits for specific patient subgroups, especially those experiencing their first acute coronary event. The findings suggest the importance of early intervention in primary prevention and emphasize the need for prompt detection of vulnerable plaque.</span></div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 2","pages":"Pages 98-99"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}