Critical Pathways in Cardiology最新文献

{"title":"Significance of platelet volume indices in acute coronary syndrome.","authors":"Sabry Abdelwahab Youssef, Ahmed Hussein Al Sharif, Mohamed Hamdy Saleh, Ahmed Rostom Abdelmoneim, Mohamed Fawzy Abdelaleem","doi":"10.1097/HPC.0000000000000440","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000440","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) is a leading global cause of mortality, driven by platelet-mediated atherothrombosis; early diagnosis improves outcomes. This study aimed to evaluate platelet volume indices, including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR), for ACS diagnosis and their prognostic value for ICU stay and in-hospital mortality. Prospective comparative study of 638 patients (381 ACS, 257 stable angina). Venous blood samples collected in EDTA tubes were analyzed for platelet count and indices within 30 minutes; 12-lead ECG and cardiac biomarkers were assessed. ICU stay and in-hospital mortality were recorded. Platelet volume indices were significantly higher in ACS patients with significant diagnostic accuracy for ACS (p-value: <0.001). Platelet counts were insignificantly lower in ACS patients (P-value: 0.189). No significant correlations between MPV, PDW, and P-LCR in ACS patients and their length of ICU stay (P-value: 0.387, 0.433, and 0.697) or incidence of in-hospital mortality (P-value: 0.125, 0.118, and 0.169), respectively. Platelet volume indices, inexpensive and widely available, effectively discriminate ACS from stable angina as early markers but lack short-term prognostic utility for ICU stay or mortality.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Influenza Vaccination on Major Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Muhammad Waqar Shahid, Abdullah Hameed, Ayesha Naseem, Fatima Sajjad, Moin Haider Shah, Hamna Khan, Afridi Jahangir Khan, Muhammad Talha Usman, Yasar Ullah, Hiba Abeer, Malaika Shakeel, Arsalan Khan, Muhammad Tariq, Muhammad Sufyan Darwesh, Muhammad Shah Zaib Khan, Abdullah Afridi, Fazia Khattak, Ahtesham Ul Haq, Hassaan Abid","doi":"10.1097/HPC.0000000000000438","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000438","url":null,"abstract":"<p><p>Cardiovascular disease remains the leading global cause of mortality despite advances in preventive therapies. Influenza infection is increasingly recognized as a trigger for acute cardiovascular events, prompting interest in influenza vaccination as a potential cardioprotective intervention in high-risk patients. We aimed to conduct a systematic review and meta-analysis to evaluate the effect of influenza vaccination on cardiovascular outcomes in adults with established cardiovascular disease. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until October 2025. Seven studies were included after the final screening. Outcomes were reported as all cause mortality, myocardial infarction, major adverse cardiovascular events and heart failure related hospitalization. Interstudy heterogeneity was assessed using I² and X² statistics. Statistical calculations were performed using Review Manager 5.4.1, with a p-value of < 0.05 indicating statistical significance. Seven randomized controlled trials including 12,224 participants were analyzed. Influenza vaccination significantly reduced major adverse cardiovascular events and cardiovascular mortality. A borderline reduction was observed for myocardial infarction and all-cause mortality. No significant differences were found for stroke, coronary revascularization, or heart failure-related hospitalization. Heterogeneity was low for most primary outcomes. The routine use of influenza vaccination as an effective adjunctive strategy in secondary cardiovascular prevention is supported by the fact that it significantly lowers cardiovascular mortality and major cardiovascular events in patients with established heart disease.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter-2 Inhibitor Use and Outcomes Following Transcatheter Aortic Valve Replacement: A Propensity-Score Matched Analysis.","authors":"Hritvik Jain, Dhiran Verghese, Jyoti Jain, Ramez M Odat, Ignacio Inglessis-Azuaje, Dhaval Kolte, Paul C Gordon, J Dawn Abbott, Saraschandra Vallabhajosyula","doi":"10.1097/HPC.0000000000000437","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000437","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to improve outcomes across all heart failure (HF) phenotypes, but their role in patients undergoing transcatheter aortic valve replacement (TAVR) remains limited.</p><p><strong>Methods: </strong>Using the TriNetX Global Collaborative Network, we identified all adults undergoing TAVR (2019-2025). Patients were divided into 2 groups - those receiving SGLT2i within 1-year post-TAVR and matched controls not receiving SGLT2i. Propensity-score matching was applied across demographics, comorbidities, medications, and labs. The primary endpoint was a composite of all-cause mortality and HF exacerbation. Secondary outcomes included major adverse cardiac and cerebrovascular events, ischemic stroke, acute myocardial infarction, and all-cause rehospitalization at 1 and 5 years.</p><p><strong>Results: </strong>Among 55,147 TAVR patients, 2,478 (4.5%) received SGLT2i. After 1:1 matching, 2,020 well-balanced patients per group were analyzed. At 1 year, SGLT2i use was associated with lower incidence of primary composite endpoint (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.69-0.80), HF exacerbation (HR 0.44, 95% CI 0.31-0.62), and all-cause rehospitalization (HR 0.41, 95% CI 0.38-0.44). Benefits persisted at 5 years with additional reduction in all-cause mortality (HR 0.84, 95% CI 0.73-0.97). Acute pancreatitis (falsification outcome) showed no association at both follow-ups.</p><p><strong>Conclusions: </strong>In a large multinational database, SGLT2i therapy after TAVR resulted in a significantly lower incidence of all-cause mortality or HF exacerbation.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining atrial fibrillation treatment success: patient-defined goals for arrhythmia burden and health-related quality of life.","authors":"Alexander E Kolomaya, Brian Zenger, Michael Torre, Andrew Redd, T Jared Bunch, Trudie Lobban, Morgan M Millar, Jonathan P Piccini, John A Spertus, Rachel Hess, Benjamin A Steinberg","doi":"10.1097/HPC.0000000000000439","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000439","url":null,"abstract":"<p><strong>Background: </strong>Despite the use of atrial fibrillation (AF) cutoff of 30s as the standard for success in most AF clinical trials, patients consider an AF Severity Scale (AFSS) of ≤ 5 or AF duration ≤ 1 hour as treatment success. Prevalence and factors associated with these patient-defined endpoints are unknown.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis using a single-site cohort of AF patients. We report rates of patient-defined treatment success (AFSS ≤ 5 or AF burden ≤ 1 hour) and multivariable analyses to identify factors associated with either successful outcome.</p><p><strong>Results: </strong>From 2019 to 2023, 2087 patients had available AFSS symptom scores and 2305 had ambulatory ECG monitoring. Of these, 862 (41%) had AFSS scores ≤5 and 1130 (49%) had AF burden ≤1 hour. After adjusted analysis, older age (OR 1.03, 95% CI 1.02-1.04, p <0.001) was associated with AFSS ≤5. Whereas female sex (OR 0.43, 95% CI 0.35-0.52, p <0.001), CKD, COPD, depression, and CHF were less likely to meet AFSS threshold. Among the AF burden cohort, age (OR 0.98, 95% CI 0.97-0.99, p <0.001), and female sex (OR 1.24, 95% CI 1.03-1.50, p=0.025) were associated with AF burden ≤ 1 hour. Unlike the AFSS cohort, medical comorbidities such as COPD and CHF, were not significantly different for meeting AF burden goal.</p><p><strong>Conclusion: </strong>Less than half of AF patients had AF-symptom scores or arrhythmia burdens reflecting patient-defined treatment success. Factors associated with reaching patient reported outcome goals were distinct from those associated with arrhythmia burden goals.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Evaluation and Management Strategies for Tricuspid Regurgitation.","authors":"Sajjad Ahmadi-Renani, Stephan von Haehling, Constanze Schmidt, Sepideh Taghavi, Marzieh Mirtajaddini, Razieh Omidvar, Nasim Naderi","doi":"10.1097/HPC.0000000000000441","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000441","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid regurgitation (TR) is a common but historically under-recognized valvular heart disease. Although mild to moderate TR was long considered benign, accumulating evidence indicates that clinically significant TR is associated with right ventricular failure, hepatic congestion, recurrent hospitalization, and increased mortality.</p><p><strong>Aims: </strong>This review aims to provide a comprehensive overview of contemporary evaluation and management strategies for TR across its clinically relevant spectrum, with particular emphasis on severe disease and secondary mechanisms when discussing intervention.</p><p><strong>Methods: </strong>Current literature was synthesized with a focus on TR classification, underlying mechanisms, imaging and hemodynamic assessment, risk stratification, device-related TR, and evolving therapeutic strategies, including both surgical and transcatheter approaches.</p><p><strong>Results: </strong>Management paradigms have shifted toward earlier recognition and intervention, with echocardiography remaining central to diagnosis and procedural planning. While medical therapy is primarily supportive, advances in transcatheter edge-to-edge repair, annuloplasty systems, and transcatheter valve replacement have significantly expanded treatment options, particularly for patients at high surgical risk. Key determinants of therapeutic decision-making include pulmonary artery pressure, right ventricle-pulmonary artery coupling, right-sided chamber remodeling, surgical risk, and anatomic suitability.</p><p><strong>Conclusion: </strong>TR represents a complex and rapidly evolving area of cardiology that requires individualized assessment based on anatomy, hemodynamics, comorbidities, and the quality of available evidence. Ongoing clinical trials and emerging therapies are expected to further refine treatment algorithms and future guideline recommendations.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiography-Derived vs Wire-Based Physiological Assessment in Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Muhammad Mudasir, Abdul Rehman, Muhammad Ibrahim Rashid, Mohammad Salah, Muhammad Jawad, Ramesha Tahir, Raja Muhammad Umer, Prem Kumar, Rohin Kumar","doi":"10.1097/HPC.0000000000000436","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000436","url":null,"abstract":"<p><p>This study aimed to determine whether angiography-based physiological assessment yields clinical outcomes comparable to those of conventional wire-based pressure measurements in patients with coronary artery disease (CAD) undergoing evaluation of intermediate coronary stenoses. A systematic literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials through April 12, 2026. Randomized controlled trials comparing angiography-derived indices (such as QFR, vFFR, and angiography-based FFR) with standard wire-based methods (FFR/iFR) were included. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model, and heterogeneity was evaluated using the I² statistic. A total of three randomized trials involving 6,141 participants were included, with 3,089 patients assigned to angiography-derived assessment. At 12 months, no statistically significant difference was observed in major adverse cardiovascular events between the two strategies (RR 1.14; 95% CI 0.58-2.25; P =.48). Additionally, outcomes including all-cause mortality, myocardial infarction, target vessel failure, repeat revascularization, stent thrombosis, stroke, and cardiac mortality were comparable across groups (all P >.05). Angiography-derived physiological assessment provides similar short-term clinical outcomes to traditional wire-based techniques, supporting its use as a less invasive alternative for assessing intermediate coronary lesions. Larger studies with extended follow-up are needed to confirm these findings.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise Training and Cardiac Remodeling in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis.","authors":"Maddison Weber, Mohammed Azouz, Ella Young, Madhulika Appajodu, John Bettag, Dominick Milkie, Amjad Kabach","doi":"10.1097/HPC.0000000000000428","DOIUrl":"10.1097/HPC.0000000000000428","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and a leading cause of sudden cardiac death in young individuals and athletes. Historically, exercise restrictions were advised because of concerns about arrhythmias, left ventricular outflow tract (LVOT) obstruction, and adverse remodeling; however, emerging evidence challenges these recommendations. To systematically evaluate the effects of structured and habitual exercise on cardiac structure, function, biomarkers, functional capacity, and safety in individuals with HCM. We performed a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized and observational studies including patients ≥12 years with confirmed HCM participating in structured exercise or habitual physical activity were eligible. Comparators included usual care, lower-intensity exercise, or sedentary controls. Outcomes included cardiac remodeling parameters (wall thickness, chamber volumes, LVOT gradient, and diastolic function), left ventricular ejection fraction, B-type natriuretic peptide, peak oxygen consumption (VO 2 peak), body mass index, and major adverse clinical events. Random-effects models were used for pooled analyses. Eleven studies (1457 participants) were included. Exercise was not associated with adverse changes in wall thickness, chamber volumes, left ventricular ejection fraction, LVOT gradient, diastolic indices, B-type natriuretic peptide, or body mass index. VO 2 peak changes were heterogeneous, with some trials demonstrating individualized functional improvement. No study reported excess adverse events, including sudden cardiac death, ventricular arrhythmias, syncope, or appropriate implantable cardioverter-defibrillator therapy. Structured and habitual exercise appear safe in HCM, without evidence of adverse remodeling or increased arrhythmic risk. Functional benefits vary, supporting individualized, supervised exercise prescriptions and more patient-centered counseling.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0428"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821705","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":"Lipid-Lowering Treatment Patterns and Risk of Subsequent Cardiovascular Outcomes in Patients With Recent Coronary Revascularization.","authors":"Casey Gazda, Pallavi B Rane, Sasikiran Nunna, Zifan Zhou, Jason Exter, Lionel Pinto, Mohdhar Habib, Catherine B McGuiness, Rolin L Wade, Matthew A Cavender","doi":"10.1097/HPC.0000000000000426","DOIUrl":"10.1097/HPC.0000000000000426","url":null,"abstract":"<p><strong>Background: </strong>Lipid-lowering reduces cardiovascular events (CVEs) in patients with coronary artery disease. We sought to understand lipid-lowering therapy (LLT), low-density lipoprotein cholesterol (LDL-C) levels, and CVEs after coronary revascularization (CR).</p><p><strong>Methods: </strong>We identified adults who underwent CR from 2014 to 2019 in linked datasets (IQVIA PharMetrics Plus health plan claims, IQVIA longitudinal prescription claims, and Prognos LDL-C database) using established methodology for extraction of deidentified claims data.</p><p><strong>Results: </strong>A total of 184,271 patients were identified, 73,619 (40.0%) of whom were hospitalized for myocardial infarction (MI) in the 30 days before the index revascularization. Utilization of LLT increased from 46.0% at 3 months prerevascularization to 92.7% 12 months postrevascularization. Only 56.4% of patients were prescribed high-intensity statins. In a subset of patients with LDL-C values (n = 5496), the mean (SD) LDL-C decreased from 108 (41) mg/dL at 6 months prerevascularization to 82 (33) mg/dL at 12 months postrevascularization ( P < 0.0001). At 12 months after revascularization, LDL-C was ≥70 mg/dL in 55.7% of patients with prior MI and 62.1% of patients without recent MI. CVEs rates (per 100 patient-years) at 12 months postrevascularization were 5.2 (95% confidence interval [CI], 5.1-5.3) for MI, 2.0 (95% CI, 1.9-2.0) for stroke, and 6.6 (95% CI, 6.5-6.7) for unstable angina.</p><p><strong>Conclusions: </strong>Although LLT utilization increased after revascularization, high-intensity statins were underutilized. LDL-C levels remained above 70 mg/dL in more than half of the patients. Systematic efforts are needed after CR to improve lipid control and prevent recurrent CV events.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0426"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333405","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":"Door-to-Electrocardiogram Time Disparities in Acute Coronary Syndrome: Predictors and Clinical Outcomes in a Contemporary Community Hospital Cohort.","authors":"Mohammed Abed, Yhia Sakr, Ali Alshlah, Dhruv Patel, Rajiv Sharma, Roddy Bernard, Zain Tariq, Julian Chen, Patryk Klimek, Harvey Nguyen, Christina Angel","doi":"10.1097/HPC.0000000000000429","DOIUrl":"10.1097/HPC.0000000000000429","url":null,"abstract":"<p><strong>Background: </strong>Door-to-electrocardiogram (D2E) time is a critical quality metric in evaluating patients with suspected acute coronary syndromes (ACS), yet adherence to the ≤10-minute benchmark remains suboptimal. This study aimed to quantify D2E performance, identify predictors of delayed electrocardiogram (EKG) acquisition, and evaluate associations between D2E delays, in-hospital mortality, and length of stay (LOS).</p><p><strong>Objective: </strong>To quantify D2E performance, identify patient- and system-level predictors of delayed EKG acquisition, and evaluate associations between D2E delays, in-hospital mortality, and LOS.</p><p><strong>Methods: </strong>This retrospective cohort study included adults presenting to a single community hospital emergency department in 2024 with symptoms suggestive of ACS. The primary outcome was receipt of a 12-lead EKG within 10 minutes of arrival. Secondary outcomes included D2E distribution, in-hospital mortality, and hospital LOS. Multivariable logistic regression examined predictors of D2E >10 minutes.</p><p><strong>Results: </strong>Among 3435 patients (median age 62 years; 52.3% female), 49.7% achieved D2E ≤10 minutes (median 10.0 minutes). In ACS subgroup analysis, female sex, atypical presentation, lower triage acuity, and afternoon shift were independently associated with D2E >10 minutes. Delayed EKG acquisition correlated with longer LOS, including a higher proportion of stays >4 days and a higher median LOS (3.0 vs. 2.0 days, P < 0.01). Overall, in-hospital mortality was 6.5%.</p><p><strong>Conclusions: </strong>Fewer than 5 in 10 patients met the 10-minute D2E target. Delays were more frequent among women, patients with atypical presentations, lower triage acuity, and those arriving during afternoon shifts. Delayed EKG acquisition was associated with prolonged hospitalization, underscoring D2E time as a modifiable process measure.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0429"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976071","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":"Aspirin Withdrawal Before 30 Days After PCI in Acute Coronary Syndrome and Early Myocardial Infarction Risk: A Systematic Review and Meta-analysis.","authors":"Khubaib Mohammad Murtafa, Sadiya Sajad Khanday, Mohammad Sameem Arif, Mir Wajid Majeed, Shahrukh Mohammed, Rumaan Rafiq Mir, Shariq Ahmad Wani, Merruna Liqua Chishti, Tabin Dilshad Kawoosa, Rachita Kour, Khalid Hamid Changal","doi":"10.1097/HPC.0000000000000425","DOIUrl":"10.1097/HPC.0000000000000425","url":null,"abstract":"<p><strong>Background: </strong>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard of care after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Although aspirin discontinuation after at least 1 month of DAPT reduces bleeding without increasing ischemic events, the safety of aspirin withdrawal before the first 30 days after PCI remains uncertain.</p><p><strong>Methods: </strong>Online databases were searched through December 2025 to identify randomized controlled trials comparing aspirin-free P2Y12 inhibitor monotherapy initiated within 30 days after PCI versus standard DAPT in ACS patients. Outcomes were assessed during short-term (0-30 days) and longer-term follow-up (31 days to 12 months). Random-effects models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Three randomized controlled trials comprising 10,736 patients were included. Within 30 days after PCI, aspirin discontinuation was associated with a higher risk of myocardial infarction (OR, 2.12; 95% CI, 1.31-3.44), without a reduction in bleeding compared with DAPT. No significant differences were observed in other ischemic, composite, or mortality outcomes. During longer-term follow-up, P2Y12 inhibitor monotherapy was associated with significant reductions in bleeding outcomes and net adverse clinical events, without an increase in ischemic outcomes.</p><p><strong>Conclusions: </strong>In ACS patients undergoing PCI with drug-eluting stent, aspirin discontinuation within 30 days did not reduce bleeding and was associated with a higher risk of myocardial infarction. These findings suggest the first 30 days after PCI may represent a period of heightened ischemic vulnerability, and routine aspirin withdrawal during this early phase should be interpreted with caution.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0425"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821707","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}