Journal of the American College of Cardiology最新文献

{"title":"Cardiac Arrest and Outcome in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction: A Pooled Analysis of Randomized Controlled Trials.","authors":"Anne Freund, Annika Rodewald, Ibrahim Akin, Georg Fuernau, Tienush Rassaf, Peter Nordbeck, Hans-Josef Feistritzer, Janine Pöss, Marko Noc, Ingo Eitel, Carsten Skurk, Lars Maier, Norman Mangner, Taoufik Ouarrak, Steffen Schneider, Steffen Desch, Uwe Zeymer, Holger Thiele","doi":"10.1016/j.jacc.2026.01.068","DOIUrl":"10.1016/j.jacc.2026.01.068","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2301-2304"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513092","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":"High-Sensitivity Cardiac Troponin T-gen6 Assay in Suspected Myocardial Infarction: Diagnostic Accuracy, Cutoffs, and Clinical Implications.","authors":"Luca Koechlin, Pedro Lopez-Ayala, Alexander J F Thurston, Yong Yong Tew, Rachel O'Brien, Alasdair Gray, Paolo Bima, Emel Kaplan, Òscar Miró, Michael Christ, Dagmar I Keller, Javier F Martin-Sanchez, Beata Morawiec, Jiri Parenica, Lourdes Herraiz Recuenco, Gabrielle Huré, Karin Wildi, Luca Crisanti, Carlos Spagnuolo, Jonas Glaeser, Catherine Caubergh, Katharina Rentsch, Ksenija Slankamenac, Héctor Rodriguez Cetina Biefer, Omer Dzemali, Ivo Strebel, Felix Mahfoud, Nicholas L Mills, Jasper Boeddinghaus, Christian Mueller","doi":"10.1016/j.jacc.2025.12.052","DOIUrl":"10.1016/j.jacc.2025.12.052","url":null,"abstract":"<p><strong>Background: </strong>The new high-sensitivity cardiac troponin (hs-cTn) T-generation (gen) 6 assay has higher analytical sensitivity than the current hs-cTnT-gen5 assay, but its clinical performance is unknown.</p><p><strong>Objectives: </strong>The authors aimed to assess the clinical performance and use-optimized cutoffs of the hs-cTnT-gen6 assay.</p><p><strong>Methods: </strong>In this secondary analysis of an international, prospective, diagnostic study with central adjudication, patients presenting with suspected myocardial infarction to the emergency department were enrolled. hs-cTnT-gen6 and hs-cTnT -gen5 were measured at the same time points. The analytical and diagnostic performance of hs-cTnT-gen6 were compared to hs-cTnT-gen5, and assay-specific cutoffs for the European Society of Cardiology 0/1- and 0/2-hour algorithms were derived and internally and externally validated.</p><p><strong>Results: </strong>Among 3,346 patients, myocardial infarction was the final diagnosis in 616 (18.4%). The proportion of patients with concentrations above the upper reference limit and therefore having myocardial injury was lower for hs-cTnT-gen6 (35.9%) than for hs-cTnT-gen5 (43.5%; P < 0.001). Diagnostic accuracy at emergency department presentation, expressed as area under the curve, was 0.927 (95% CI: 0.918-0.937) for hs-cTnT-gen6 and 0.931 (95% CI: 0.921-0.94) for hs-cTnT-gen5. A gen6 cutoff of <6 ng/L ruled out non-ST-segment elevated myocardial infarction in 30.0% of patients with 100% sensitivity (95% CI: 99.4%-100%) irrespective of chest pain onset. An hs-cTnT-gen6 cutoff of <8 ng/L at presentation (if chest pain onset was >3 hours) or <18 ng/L together with a 0/1-hour delta of <2 ng/L ruled out 56.3% with a sensitivity of 99.7% (95% CI: 98.3%-99.9%). An hs-cTnT-gen6 concentration ≥112 ng/L or a 0/1-hour delta ≥10 ng/L ruled-in 20.0% with a specificity of 93.4% (95% CI: 92.0%-94.6%). An hs-cTnT-gen6 cutoff <8 ng/L at presentation (if chest pain onset was >3 hours) or <18 ng/L together with a 0/2-hour delta of <4 ng/L ruled out 51.1% with a sensitivity of 99.7% (95% CI: 98.1%-99.9%). An hs-cTnT-gen6 concentration ≥112 ng/L or a 0/2-hour delta ≥15 ng/L ruled-in 23.9% with a specificity 92.7% (95% CI: 90.8%-94.2%). Findings were consistent in sensitivity analyses as well as in the external validation cohort.</p><p><strong>Conclusions: </strong>The novel hs-cTnT-gen6 assay demonstrated excellent and comparable diagnostic performance to the established hs-cTnT-gen5 assay with fewer patients identified as having myocardial injury. Use-optimized, assay-specific cutoffs for the European Society of Cardiology 0/1- and 0/2-hour algorithms provided very high sensitivity and high specificity. (Advantageous Predictors of Acute Coronary Syndromes Evaluation Study [APACE]; NCT00470587).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2236-2257"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513214","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":"On the Other Side of the Bed: An Ode to the Coronary Care Unit.","authors":"Harlan M Krumholz","doi":"10.1016/j.jacc.2026.03.077","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.03.077","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"87 17","pages":"2209-2210"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839551","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":"Digital Interventions For Postmyocardial Infarction Cardiac Anxiety: Treating an Unmet Need, But Are They Accessible?","authors":"Leslie L Davis","doi":"10.1016/j.jacc.2026.03.028","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.03.028","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"87 17","pages":"2322-2324"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839577","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":"The cTnI/cTnT Ratio in Myocardial Injury: A Multicohort and Experimental Synthesis.","authors":"Tobias Zimmermann, Luca Koechlin, Joan Walter, Dorien M Kimenai, Anda Bularga, Giulia Milan, Antonio Sileo, Deborah Fusco, Xiya Mu, Fabian J Brunner, Christoph Waldeyer, Nils A Sörensen, Johannes T Neumann, Aida Muslimovic, Kristina Vukusic, Thomas Nestelberger, Jasper Boeddinghaus, Pedro Lopez-Ayala, Klara Rumora, Christian Puelacher, Danielle M Gualandro, Katharina Rentsch, Ivo Strebel, Matthias Diebold, Raphael Twerenbold, Bertil Lindahl, Ellen J S Denessen, Alma M A Mingels, Steven Meex, Nicholas L Mills, Anna Marsano, Ola Hammarsten, Christian Mueller","doi":"10.1016/j.jacc.2025.12.078","DOIUrl":"10.1016/j.jacc.2025.12.078","url":null,"abstract":"<p><strong>Background: </strong>Cardiac troponin (cTn) I and cTnT are used interchangeably in clinical practice, despite emerging evidence from pilot studies that the cTnI/cTnT ratio may differ in acute necrotic vs chronic or non-necrotic myocardial injury.</p><p><strong>Objectives: </strong>The purpose of this study was to challenge the interchangeability of cTnI and cTnT and to test the cTnI/cTnT ratio as a biologically meaningful construct of the type and severity of myocardial injury across a large, adjudicated multicohort population, validate the signal across multiple assays and external data sets, and pair clinical observations with experimental models that replicate the directional signal.</p><p><strong>Methods: </strong>Participants from 3 prospective clinical studies with centrally adjudicated diagnoses were grouped as having no known, chronic, or acute cardiac disease. Circulating concentrations of hs-cTnI (Architect) and hs-cTnT (Elecsys) were measured, and regression models were used to examine how the cTnI/cTnT ratio relates to these diagnostic categories and its diagnostic utility. Findings were validated both internally and externally, and the cTnI/cTnT ratio was further explored in 4 experimental cardiomyocyte models simulating mild nonlethal and lethal injury.</p><p><strong>Results: </strong>Among 9,704 individuals, the cTnI/cTnT ratio was highest in acute cardiac disease (2.06; 95% CI: 1.89-2.26), approximately 4-fold greater than in chronic (0.66; 95% CI: 0.60-0.72) and no known cardiac disease (0.50; 95% CI: 0.43-0.59). Findings were consistent across alternative hs-cTnI assays and external validation cohorts. In experimental models, mild nonlethal injury yielded cTnT-dominant release (cTnI/cTnT ratio ∼0.5), whereas lethal injury produced cTnI-dominant release (cTnI/cTnT ratio >1). Incorporating the cTnI/cTnT ratio as a predictor in a statistical model alongside cTnI and cTnT improved discrimination between type 1 and 2 acute myocardial infarction (AUC 0.73; 95% CI: 0.70-0.76 vs 0.70; 95% CI: 0.67-0.73; P < 0.01).</p><p><strong>Conclusions: </strong>The cTnI/cTnT ratio distinguishes acute necrotic from chronic/non-necrotic myocardial injury in clinical and experimental studies, and improves type 1 vs type 2 AMI discrimination, offering potential diagnostic value and challenging the interchangeability of cTnI and cTnT.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2211-2230"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284053","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":"Effect of Tocilizumab on Pro-B-Type Natriuretic Peptide and Infarct Size in Patients With Acute Myocardial Infarction at Risk of Cardiogenic Shock (DOBERMANN-T).","authors":"Joakim Bo Kunkel, Sarah Louise Duus Holle, Christian Hassager, Redi Pecini, Sebastian Wiberg, Pernille Palm, Lene Holmvang, Lia Evi Bang, Jesper Kjærgaard, Kathrine Aagaard Myhr, Mikkel Bjerg Andersen, Yusuf Abdi Isse, Jakob Hartvig Thomsen, Rasmus Paulin Beske, Thomas Engstrøm, Jacob Eifer Møller, Jacob Thomsen Lønborg, Martin Frydland, Helle Søholm","doi":"10.1016/j.jacc.2026.01.019","DOIUrl":"10.1016/j.jacc.2026.01.019","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2305-2309"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377597","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":"DOBERMANN and the Preshock Window: Can We Intervene Before the \"Bite?\"","authors":"Shashank S Sinha, Vanessa Blumer, Ajar Kochar, Manreet K Kanwar, Jason N Katz, David A Morrow","doi":"10.1016/j.jacc.2026.02.5107","DOIUrl":"10.1016/j.jacc.2026.02.5107","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2315-2317"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486533","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":"More ECMO Flow, Same PCWP: Just What the Model Tells Us.","authors":"Christiaan L Meuwese, Dirk W Donker, Libera Fresiello, Nicolas M van Mieghem, Michael Broomé","doi":"10.1016/j.jacc.2025.09.1612","DOIUrl":"10.1016/j.jacc.2025.09.1612","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"e735-e736"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966506","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":"Optimizing Approaches to Detect Patients With NSTEMI With Accelerated Diagnostic Protocols in the Emergency Department Setting.","authors":"Christopher W Baugh, Simon A Mahler, Alexander T Limkakeng, Yader Sandoval","doi":"10.1016/j.jacc.2025.12.058","DOIUrl":"10.1016/j.jacc.2025.12.058","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2279-2281"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220187","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":"Passing the Torch?: A Next-Generation High-Sensitivity Cardiac Troponin T Assay.","authors":"Cian P McCarthy, James L Januzzi","doi":"10.1016/j.jacc.2026.01.012","DOIUrl":"10.1016/j.jacc.2026.01.012","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"2258-2260"},"PeriodicalIF":22.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512994","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}