World Journal of Cardiology最新文献

{"title":"Thoracic endovascular <i>vs</i> open surgical repair in descending thoracic aortic aneurysms: A systematic review and meta-analysis.","authors":"Muneeb Khawar, Umad Ali, Malik Abdullah Rasheed, Abdul Basit Rasheed, Syed Abdullah Shah, Sarmad Zain, Muneeb Saifullah, Moosa Mubarika, Mirza Muhammad Hadeed Khawar, Talha Iqbal, Shameer Iqbal Ghuman, Ikra Rana, Prutha Pathak","doi":"10.4330/wjc.v17.i10.110962","DOIUrl":"10.4330/wjc.v17.i10.110962","url":null,"abstract":"<p><strong>Background: </strong>Descending thoracic aortic aneurysms are dangerous and have to be treated quickly. The primary treatment methods are thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR). The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis, focusing on perioperative and long-term outcomes.</p><p><strong>Aim: </strong>To compare and contrast the efficacy and safety of TEVAR <i>vs</i> OSR in the treatment of descending thoracic aortic aneurysms. This study aims to assess both perioperative and long-term outcomes through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, EMBASE, and Cochrane was conducted from inception to January 2025. Baseline characteristics and outcomes were evaluated. Odds ratios (OR) for dichotomous data and mean differences for continuous data with 95% confidence intervals (CI) were analyzed using random-effects models.</p><p><strong>Results: </strong>A meta-analysis of 21 studies involving 29465 patients (8261 TEVAR; 21204 OR) showed TEVAR associated with lower operative mortality (OR = 0.60, 95%CI: 0.42-0.85, <i>P</i> = 0.004), shorter intensive care unit (-2.94 days, 95%CI: -4.76 to -1.12, <i>P</i> = 0.002) and hospital stays (-7.35 days, 95%CI: -10.54 to -4.17, <i>P</i> < 0.00001), and reduced rates of paraplegia (OR = 0.44, 95%CI: 0.27-0.73, <i>P</i> = 0.002), spinal ischemia (OR = 0.30, 95%CI: 0.16-0.56, <i>P</i> = 0.0002), renal failure (OR = 0.29, 95%CI: 0.14-0.61, <i>P</i> = 0.001), and wound infections (OR = 0.28, 95%CI: 0.13-0.61, <i>P</i> = 0.001). However, TEVAR had higher rates of vascular complications. No significant differences were noted in 1-year and 5-year mortality rates, the rate of non-elective surgery, neurological complications, or stroke rates.</p><p><strong>Conclusion: </strong>Compared to EVAR, TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators, including hospital and intensive care unit stays, as well as fewer complications, except for those related to vascular problems. Mortality results were also similar in the long run; consequently, more research is required concerning the long-term durability.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"110962"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty status and outcomes of percutaneous coronary intervention in elderly patients with non-ST-elevation myocardial infarction.","authors":"Apurva Popat, Roopeessh Vempati, Lakshmi Sai Meghana Kodali, Alla Sai Santhosha Mrudula, Fadi Haddad, Akhil Jain, Geetha Krishnamoorthy, Param Sharma","doi":"10.4330/wjc.v17.i10.111870","DOIUrl":"10.4330/wjc.v17.i10.111870","url":null,"abstract":"<p><strong>Background: </strong>Non-ST-elevation myocardial infarction (NSTEMI) is a prevalent acute coronary syndrome among the elderly, a population often underrepresented in clinical trials. Frailty, a marker of physiologic vulnerability, may influence the risks and benefits of percutaneous coronary intervention (PCI) in these patients.</p><p><strong>Aim: </strong>To evaluate the impact of frailty status on in-hospital outcomes among patients aged ≥ 75 years with NSTEMI undergoing PCI.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the 2021-2022 National Inpatient Sample to evaluate the impact of frailty on in-hospital outcomes among NSTEMI patients aged ≥ 75 years undergoing PCI. Patients were stratified into three frailty categories using the Hospital Frailty Risk Score. Multivariable logistic and generalized linear models with interaction terms assessed the association between frailty and clinical outcomes.</p><p><strong>Results: </strong>Among 456690 NSTEMI admissions, 37.95%, 50.71%, and 11.34% were categorized as low, intermediate, and high frailty, respectively. PCI use declined with increasing frailty (35.0% in low <i>vs</i> 7.5% in high; <i>P</i> < 0.001). Adjusted mortality was lower with PCI across all frailty levels [odds ratios (OR): 0.27 (low), 0.37 (intermediate), 0.43 (high); all <i>P</i> < 0.001]. However, the mortality benefit was attenuated with increasing frailty (interaction OR: 1.56 and 1.83 for intermediate and high <i>vs</i> low frailty; <i>P</i> < 0.001). Frailty was independently associated with higher odds of complications, including acute kidney injury, respiratory failure, delirium, and bleeding. PCI was associated with shorter hospital stays in low (-0.90 days) but longer in the high-frail category (+2.47 days; <i>P</i> < 0.001), and increasing frailty correlated with significantly higher hospital charges.</p><p><strong>Conclusion: </strong>In elderly NSTEMI patients, PCI conferred a survival benefit across all frailty strata, although with a diminishing magnitude as frailty increased. Frailty correlated with increased complications and healthcare resource utilization.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"111870"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart-brain axis, gliotransmitters and peripheral neurogenesis: Emerging regenerative roles of cardiac nexus glia in health and disease.","authors":"Abirami Sekhar, Mahesh Kandasamy","doi":"10.4330/wjc.v17.i10.109174","DOIUrl":"10.4330/wjc.v17.i10.109174","url":null,"abstract":"<p><p>The heart and brain are functionally synchronized through the heart-brain axis, also known as the neurocardiac axis. Astrocytes are the predominant subpopulation of glial cells in the central nervous system that play an integral role in maintaining homeostasis, neurovascular coupling, and synaptic transmission. Radial astroglia are recognized as a potential source for the generation of new neurons in the brain, a process known as neurogenesis, accounting for neuroplasticity. While brain-resident astrocytes have been extensively studied, increasing experimental evidence has demonstrated the presence of astroglial-like cells in various organs, including the heart. The existence of astrocyte-like cells in the heart, known as cardiac nexus glia, is recognized as an emerging key modulator of cardiac function and blood flow. Similar to astrocytes, cardiac nexus glia can also release different gliotransmitters, including brain-derived neurotrophic factor, thereby modulating neurocardiac interactions. This review delves into the mechanistic insights of the cardiac nexus glia and emphasizes a hypothesis that these glial cells may possess the multipotent capacity to generate neurons, astrocytes, and oligodendrocytes, suggesting that peripheral neurogenesis could occur in the heart. As astrocytes are vital for neuroplasticity, the regulation of cardiac nexus glia may support heart-brain communication, while their dysfunction could lead to neurocardiac disorders.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"109174"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological interventions to enhance exercise capacity in patients with heart failure.","authors":"Ryo Naito","doi":"10.4330/wjc.v17.i10.110072","DOIUrl":"10.4330/wjc.v17.i10.110072","url":null,"abstract":"<p><p>Heart failure (HF) is characterized by unbalanced oxygen demand and supply and impaired exercise capacity, which substantially affects the quality of life and prognosis of patients with HF. Cardiac rehabilitation is an effective intervention for improving exercise intolerance in patients with cardiovascular diseases, including HF. However, cardiac rehabilitation is not always accessible to these patients because a restricted number of hospitals offer cardiac rehabilitation, and access to these hospitals is limited to those who require rehabilitation. Although pharmacological interventions may help improve exercise capacity in patients with HF, evidence for this intervention is scarce. This mini-review summarizes the available research on the effects of pharmacological therapies on improving exercise capacity.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"110072"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior pericardiotomy: An effective strategy for reducing post-coronary artery bypass grafting complications, with considerations for pleural effusion risk.","authors":"Muneeb Khawar, Syed Abdullah Shah, Ayesha Khan, Abdullah Waseem, Hanan Saeed, Ayesha Fatima, Muneeb Saifullah, Abbas Muhammad Mehdi, Abdul Qadeer, Mirza Muhammad Hadeed Khawar","doi":"10.4330/wjc.v17.i10.110793","DOIUrl":"10.4330/wjc.v17.i10.110793","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting (CABG), contributing to increased morbidity and prolonged hospital stays. Posterior pericardiotomy (PP), a surgical technique involving incision of the posterior pericardium to allow drainage, has been suggested as a preventive measure. However, its overall efficacy and safety profile, including potential risks like pleural effusion, require comprehensive evaluation amid varying study qualities. We hypothesized that PP reduces key post-CABG complications compared to standard care.</p><p><strong>Aim: </strong>To determine the efficacy of PP in reducing postoperative complications following CABG.</p><p><strong>Methods: </strong>This systematic review and meta-analysis included randomized controlled trials (RCTs) from PubMed, Cochrane, ClinicalTrials.gov, and Ovid, comparing PP <i>vs</i> no PP in adult CABG patients. Studies were conducted in tertiary care hospital settings. Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria. The intervention involved intraoperative PP. Primary outcome was postoperative atrial fibrillation (POAF); secondary outcomes included effusions, tamponade, hospital/intensive care unit stay, and bleeding revisions. Risk ratios (RRs), mean differences, and 95% confidence intervals (CIs) were calculated using random-effects models; heterogeneity assessed <i>via I</i> ² statistic.</p><p><strong>Results: </strong>Twenty RCTs analyzed 5331 patients (2665 with PP <i>vs</i> 2666 without). PP significantly lowered POAF (10% <i>vs</i> 21%; RR = 0.48, 95%CI: 0.36-0.65, <i>P</i> < 0.00001; <i>I</i> ² = 70%), cardiac tamponade (0.5% <i>vs</i> 3%; RR = 0.16, 95%CI: 0.08-0.34, <i>P</i> < 0.00001; <i>I</i> ² = 0%), early pericardial effusion (2% <i>vs</i> 6%; RR = 0.31, 95%CI: 0.14-0.68, <i>P</i> = 0.004; <i>I</i> ² = 96%), and late pericardial effusion (1% <i>vs</i> 9%; RR = 0.11, 95%CI: 0.05-0.21, <i>P</i> < 0.00001; <i>I</i> ² = 0%). Hospital stay decreased (mean difference = -1.23 days, 95%CI: -1.87 to -0.59, <i>P</i> = 0.0002; <i>I</i> ² = 85%). Pleural effusion risk increased (25% <i>vs</i> 17%; RR = 1.46, 95%CI: 1.21-1.76, <i>P</i> < 0.0001; <i>I</i> ² = 0%). No significant effects on mortality (RR = 0.92, 95%CI: 0.48-1.76, <i>P</i> = 0.80; <i>I</i> ² = 0%), intensive care unit stay, or bleeding revisions.</p><p><strong>Conclusion: </strong>PP effectively reduces POAF, pericardial effusions, tamponade, and hospital stay in CABG patients, though it increases pleural effusion risk and shows heterogeneity in some outcomes.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"110793"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of catheter-based interventions in treating pulmonary embolism.","authors":"George Latsios, Nikolaos Ktenopoulos, Leonidas Koliastasis, Anastasios Apostolos, Ioannis Kachrimanidis, Emmanouil Mantzouranis, Elias Tolis, Vasileios Mantziaris, Ioannis Skalidis, Sotirios Tsalamandris, Maria Drakopoulou, Andreas Synetos, Constantina Aggeli, Costas Tsioufis, Konstantinos Toutouzas","doi":"10.4330/wjc.v17.i10.111598","DOIUrl":"10.4330/wjc.v17.i10.111598","url":null,"abstract":"<p><p>Pulmonary embolism (PE) ranks as the third leading cause of cardiovascular-related deaths in Western nations. Patients classified as high-risk (HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow. While intermediate-HR (IHR) individuals remain hemodynamically stable, they face a significant chance of clinical decline and thus need close and continuous observation. Effective risk assessment, mortality prediction, and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies. Catheter-directed therapy (CDT) has emerged as a promising option, offering the ability to alleviate clot burden and reduce strain on the right ventricle, all while posing a lower risk of major bleeding compared to systemic thrombolysis. The growing adoption of CDT reflects its increasing relevance in PE treatment, especially when managed by specialized PE response teams that ensure individualized, multidisciplinary care. As clinical practices evolve, further studies and robust clinical trials are necessary to clearly define CDT's role in lowering the risks of complications and death among IHR PE patients. This article explores the current understanding and future direction of managing PE, focusing in the role of catheter-based interventions.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"111598"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose cotransporter 2 inhibitor in heart failure patients and their outcomes: A meta-analysis of randomized controlled trials.","authors":"Saketh Parsi, Pallavi D Shirsat, Lakshmi P Mahali, Salim Surani, Rahul Kashyap","doi":"10.4330/wjc.v17.i10.109731","DOIUrl":"10.4330/wjc.v17.i10.109731","url":null,"abstract":"<p><strong>Background: </strong>The use of sodium-glucose cotransporter 2 (SGLT2) inhibitor in heart failure (HF) patients is increasing significantly, regardless of whether they have a history of diabetes. The effects of SGLT2 inhibitor on HF are likely mediated through multiple mechanisms, including suppression of the renin-angiotensin-aldosterone system (RAAS), reduction in oxidative stress leading to enhanced myocardial efficiency, and attenuation of adverse cardiac remodeling by preventing fibrosis. These pathways are fundamental to reducing mortality, improving patients' quality of life, and alleviating the burden on the United States healthcare system by decreasing HF-related hospitalizations.</p><p><strong>Aim: </strong>To evaluate SGLT2 inhibitor effects on HF, focusing on hospitalization for HF (HHF), cardiovascular (CV) deaths, and all-cause mortality.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed for randomized controlled trials (RCTs) evaluating the effects of SGLT2 inhibitor in HF patients compared to placebo, covering the period from January 1, 2014, to January 1, 2025. The primary outcomes assessed were HHF, CV deaths, and all-cause mortality. RevMan Web 5.4.1 was used to assess the risk of bias heterogeneity and to perform the statistical analyses. A random-effects model was employed for all statistical evaluations.</p><p><strong>Results: </strong>A total of nine RCTs were included in this analysis: DELIVER, DECLARE-TIMI 58, DAPA-HF, EMPA-REG OUTCOME, EMPEROR-Reduced, EMPEROR-Preserved, SOLOIST-WHF, EMPULSE, and VERTIS-CV. For HHF, eight trials (excluding the SOLOIST-WHF; <i>n</i> = 25906) were pooled, while CV deaths were assessed using data from eight trials (excluding the EMPULSE; <i>n</i> = 26598). Compared to placebo, SGLT2 inhibitor significantly reduced the risk of HHF (relative risk: 0.74; 95%CI: 0.71-0.77; <i>P</i> < 0.00001) and CV death (odds ratio: 0.88; 95%CI: 0.83-0.92; <i>P</i> = 0.0006). All nine trials (<i>n</i> = 27128) were included in the analysis of all-cause mortality. SGLT2 inhibitor were associated with a statistically significant reduction in all-cause mortality compared to placebo (OR: 0.91; 95%CI: 0.84-0.98; <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>These results suggest that SGLT2 inhibitor significantly reduce the risk of hospitalization for HF, CV deaths, and all-cause mortality.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"109731"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasospastic angina: Pathophysiology, diagnosis, and emerging therapeutic approaches.","authors":"Kristoffer Ken Ralota, Jamie Layland","doi":"10.4330/wjc.v17.i10.108594","DOIUrl":"10.4330/wjc.v17.i10.108594","url":null,"abstract":"<p><p>Vasospastic angina (VSA) is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis. It is an underdiagnosed and often challenging condition that can lead to recurrent angina, myocardial infarction, and sudden cardiac death. VSA arises from a multifactorial interplay of endothelial dysfunction, vascular smooth muscle hyperreactivity, inflammation, and autonomic dysregulation. While calcium channel blockers and nitrates remain the mainstay of therapy, there is a growing body of evidence in the use of novel and emerging treatments including Rho-kinase inhibitors, endothelin receptor antagonists, and anti-inflammatory agents for refractory cases. Diagnostic evaluation relies on clinical features and, when necessary, invasive coronary pharmacological provocation testing. This narrative review examines the current understanding of VSA, discusses current international guideline-based diagnostic and therapeutic strategies, and highlights novel and investigational approaches that may broaden the treatment armamentarium against it.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"108594"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual versus single antiplatelet therapy after lower extremity revascularization in peripheral artery disease: A systematic review and meta-analysis.","authors":"Mohammad Maroof Shahid, Debvarsha Mandal, Ashesh Das, Pershan Kumar, Nikil Kumar, Absar Mukhtar, Hooria Ejaz, Muhammad Soban Jaffar, Mavia Habib, Ayesha Afzal, Mirza Muhammad Hadeed Khawar, Ikra Rana","doi":"10.4330/wjc.v17.i10.111941","DOIUrl":"10.4330/wjc.v17.i10.111941","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) affects millions globally, with a 5.6% prevalence in 2015 impacting 236 million adults, rising above 10% in those over 60 due to factors like diabetes and smoking. Post-revascularization, single antiplatelet therapy (SAPT) is standard, but dual antiplatelet therapy (DAPT) may improve outcomes, though duration and bleeding risks are unclear. The 2024 American College of Cardiology/American Heart Association guidelines endorse short-term DAPT, yet evidence gaps remain in comparative efficacy and safety. We hypothesized that DAPT reduces cardiovascular events and reinterventions <i>vs</i> SAPT without significantly elevating bleeding in PAD patients' post-lower extremity revascularization.</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of DAPT <i>vs</i> SAPT in PAD patients' post-revascularization.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching PubMed, EMBASE, and ScienceDirect up to July 2025. Included were randomized controlled trials (RCTs) and cohort studies from various global settings (<i>e.g.</i>, hospitals, tertiary care) comparing DAPT (aspirin plus P2Y12 inhibitor for > 1 month) to SAPT in symptomatic PAD patients undergoing endovascular or surgical revascularization (<i>n</i> up to 28244 participants selected <i>via</i> eligibility criteria). Data were pooled using random-effects models for risk ratio (RR) with 95%CI; heterogeneity was assessed <i>via</i> the <i>I</i>² statistic. Quality appraisal used Risk of Bias in Non-randomized Studies of Interventions for cohorts and Risk of Bias 2.0 for RCTs; certainty was evaluated <i>via</i> Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>Twelve studies (3 RCTs, 9 cohorts, conducted 2010-2025 with follow-ups of 6 months to 5 years) were included. DAPT showed no significant difference but a trend toward reduced all-cause mortality (RR: 0.52, 95%CI: 0.27-1.01, <i>P</i> = 0.05, DAPT of 298/9545 events <i>vs</i> SAPT of 165/566 events) or stroke (RR: 0.72, 95%CI: 0.30-1.72, <i>P</i> = 0.46, DAPT of 16/3729 events <i>vs</i> SAPT of 41/7673 events) <i>vs</i> SAPT. DAPT significantly reduced cardiac mortality (RR: 0.46, 95%CI: 0.27-0.80, <i>P</i> = 0.006, DAPT of 78/2903 events <i>vs</i> SAPT of 171/1465 events, risk difference: -5.4%), myocardial infarction (RR: 0.82, 95%CI: 0.71-0.94, <i>P</i> = 0.004, DAPT of 233/7704 events <i>vs</i> SAPT of 262/9130 events, risk difference: -1.8%), and major reintervention (RR: 0.58, 95%CI: 0.35-0.98, <i>P</i> = 0.04, DAPT of 803/205 events <i>vs</i> SAPT of 1197/4 events, risk difference: -42%). Bleeding showed no difference (RR: 1.12, 95%CI: 0.42-3.03, <i>P</i> = 0.82, DAPT of 195/2775 events <i>vs</i> SAPT of 202/8234 events). Heterogeneity was high (<i>I</i> ² = 59%-97%). Quality revealed mo","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"111941"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality prediction in ventricular septal rupture at high altitude: A novel tool for resource-limited regions.","authors":"Kristina G Pereverzeva","doi":"10.4330/wjc.v17.i10.112428","DOIUrl":"10.4330/wjc.v17.i10.112428","url":null,"abstract":"<p><p>The innovative study by Zhang <i>et al</i> published in the <i>World Journal of Cardiology</i> focused on predicting 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture at high altitudes. Based on a retrospective analysis of 48 patients from Yunnan Province, China, the authors identified four independent predictors of mortality: Age; Elevated uric acid levels; Interleukin-6 and decreased hemoglobin. Integrating these factors into a nomogram demonstrated high predictive accuracy (area under the curve = 0.939). This model addressed the critical challenge of risk stratification in the resource-limited settings typical of high-altitude areas. This editorial underscored the practical value of the nomogram for timely identification of candidates for intensive therapy and surgical intervention while emphasizing the need for model validation in multicenter cohorts to optimize the management of these patients.</p>","PeriodicalId":23800,"journal":{"name":"World Journal of Cardiology","volume":"17 10","pages":"112428"},"PeriodicalIF":2.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}