Critical Pathways in Cardiology最新文献

{"title":"Hyperuricemia and Cardiovascular Risk: Insights and Implications.","authors":"Abdalhakim Shubietah, Ameer Awashra, Fathi Milhem, Mohammad Ghannam, Moath Hattab, Islam Rajab, Haroun Neiroukh, Massa Zahdeh, Ahmad Nouri, Abdalrahman Assaassa, Kiran Nair, Ankit Sahni, Anan Abu Rmilah","doi":"10.1097/HPC.0000000000000388","DOIUrl":"10.1097/HPC.0000000000000388","url":null,"abstract":"<p><p>Hyperuricemia, characterized by elevated serum uric acid levels, has been linked to cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, metabolic syndrome, and coronary artery disease. This relationship, however, is complex; while some studies indicate a strong association, others suggest that it may be influenced by confounding factors. The rising global prevalence of hyperuricemia underscores the necessity for a deeper understanding of its cardiovascular implications. Hyperuricemia results from an imbalance in uric acid production and excretion, driven by dietary factors, obesity, insulin resistance, and other conditions. Elevated uric acid levels contribute to cardiovascular risk through mechanisms such as inflammation, oxidative stress, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system. This review highlights the importance of ongoing research to clarify hyperuricemia's role in cardiovascular disease and suggests that urate-lowering therapies, such as xanthine oxidase inhibitors, may confer cardiovascular benefits; however, evidence remains conflicting. The Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial indicated an increased risk of cardiovascular and all-cause mortality with febuxostat compared with allopurinol, raising safety concerns. In contrast, the Febuxostat versus Allopurinol Streamlined Trial (FAST) demonstrated that febuxostat was noninferior to allopurinol, with even lower all-cause mortality. These opposing findings emphasize the complexity of treatment decisions and the need for individualized management strategies for hyperuricemia. Clinical decisions should consider individual patient risks and characteristics. Ultimately, this comprehensive analysis aims to enhance prevention and management strategies for cardiovascular diseases related to hyperuricemia. The overview includes discussions on major studies such as the Framingham Heart Study, CARES, FAST, PRIZE, and FREED trials, examining their results. It explores whether hyperuricemia is a causal factor versus an associated risk factor and whether it serves as a marker or mediator of disease. Additionally, the review addresses novel biomarkers and predictive models, the management of hyperuricemia in the context of cardiovascular risk, the role of urate-lowering therapies in cardiovascular disease, variability in guidelines and recommendations, and the impact of hyperuricemia in special populations such as those with diabetes and chronic kidney disease. The cardiovascular risk associated with hyperuricemia across various demographics is also discussed. Furthermore, the review suggests that existing risk scores might be modified to include uric acid levels in patients with hyperuricemia.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0388"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587574","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":"Acute Prevention of the Heart Attack: The Identification of Prodromal Symptom Recognition as the \"Rosetta Stone\" in Decoding the Heart Attack Problem.","authors":"Raymond D Bahr, Frank Breuckmann","doi":"10.1097/HPC.0000000000000395","DOIUrl":"10.1097/HPC.0000000000000395","url":null,"abstract":"<p><p>Chest discomfort before severe chest pain represents a clinical ischemia marker and indicates live myocardium in jeopardy and often precedes cardiac arrest or acute myocardial infarction (MI). The intermittent or stuttering symptoms that precede MI are referred to as \"prodromal symptoms.\" These symptoms have been shown to correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the acute ischemia precedes to death or heart damage. These symptoms of premonitory angina have been associated with improved outcomes due to ischemic preconditioning or opening of collateral vascular channels around the area of ischemia. Acute prevention of an MI through prodromal symptoms recognition represents the opportunity for significantly reducing heart attack deaths. The early heart attack care program puts emphasis on prodromal symptom recognition and allows a shift in time backward to prevent the ischemic process from proceeding to MI. This strategy has been shown to pick up 15% of the patients with ischemia in the low probability group and to reduce inappropriate admissions to the hospital, as well as to reduce the number of patients with missed MIs being sent home from the emergency department.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0395"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175126","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":"Initiating Preventive Care for Hyperlipidemia in the Emergency Department: The Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders Trial.","authors":"Nicklaus P Ashburn, Anna C Snavely, Molly R Ehrig, Michael D Shapiro, David M Herrington, David M Reboussin, Sabina B Gesell, Simon A Mahler","doi":"10.1097/HPC.0000000000000390","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000390","url":null,"abstract":"<p><strong>Background: </strong>Hyperlipidemia (HLD) is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Nearly 30% of emergency department (ED) patients with chest pain have undiagnosed and/or unmanaged HLD, putting them at an increased risk of ASCVD. Although safe and effective HLD treatments exist, the ED traditionally focuses on acute care and does not offer preventive cardiovascular care services. This represents a large, missed opportunity to improve cardiovascular health for the millions of Americans evaluated in the ED each year who are not receiving appropriate preventive care in the outpatient setting. The goals of this study are to determine the efficacy of novel ED-initiated preventive care on lowering cholesterol while also informing our understanding of patient adherence and implementation determinants of ED-initiated preventive cardiovascular care.</p><p><strong>Methods: </strong>We will use a randomized, controlled, parallel-group trial of 130 ED patients being evaluated for acute coronary syndrome at a single site. Participants will be 40-75 years old with prior ASCVD, known diabetes, or 10-year ASCVD risk ≥7.5% who are not already receiving guideline-directed outpatient preventive care. Patients will be randomized with equal probability to EMERALD (Emergency Medicine Cardiovascular Risk Assessment for Lipid Disorders) or usual care. Patients in the EMERALD arm will be started on a statin and referred for a 30-day follow-up with cardiology or primary care, depending on the 10-year ASCVD risk level. Usual care arm patients will not be prescribed a statin in the ED and will be asked to follow up with a primary care provider. The primary outcome will be a percent change in low-density lipoprotein cholesterol at 30 days. Secondary outcomes include percent change in low-density lipoprotein cholesterol at 180 days and nonhigh-density lipoprotein cholesterol at 30- and 180 days, the proportion of EMERALD patients who pick up their statin, and the proportion of patients who attend 30-day outpatient follow-up. We will also use mixed methods and semistructured interviews to identify patient adherence facilitators and barriers and implementation determinants for Emergency Medicine providers.</p><p><strong>Discussion: </strong>This is the first study to evaluate a novel, protocolized ED-initiated preventive cardiovascular care approach for HLD. If successful, the EMERALD intervention may be able to improve the cardiovascular health for at-risk patients and serve as a use case for other modifiable cardiovascular disease risk factors, such as diabetes, hypertension, tobacco use, and obesity. This single-site study will inform a planned multisite trial.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"24 3","pages":"e0390"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972545","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":"Implications of Atrial Fibrillation in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries.","authors":"Abdul Rasheed Bahar, Yasemin Bahar, Paawanjot Kaur, George Kidess, Mohamad Hasan Jawadi, Mohamed S Alrayyashi, Olayiwola Bolaji, Timir K Paul, M Chadi Alraies","doi":"10.1097/HPC.0000000000000391","DOIUrl":"10.1097/HPC.0000000000000391","url":null,"abstract":"<p><strong>Background: </strong>Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as myocardial infarction with <50% stenosis of coronary arteries. Atrial fibrillation (AF) is a common arrhythmia that may influence MINOCA outcomes.</p><p><strong>Methods: </strong>We performed a retrospective analysis of the National Inpatient Sample (2016-2021), identifying MINOCA patients with and without AF using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariable mixed-effects logistic regression and propensity score matching were applied to control for confounders and assess outcomes.</p><p><strong>Results: </strong>Of 94,840 MINOCA patients, 28,270 (30%) had AF. AF was associated with higher in-hospital mortality (3.74% vs. 2.75%; P = 0.004), acute heart failure (38.33% vs. 34.97%; P < 0.001), sudden cardiac arrest (2.54% vs. 1.73%; P < 0.050), and cardiogenic shock (3.11% vs. 1.56%; P < 0.001). AF independently predicted in-hospital mortality [adjusted odds ratio (aOR), 1.3; 95% confidence interval (CI), 1.07-1.58; P < 0.001], heart failure (aOR, 1.48; 95% CI, 1.38-1.59; P < 0.001), cardiogenic shock (aOR, 1.85; 95% CI, 1.48-2.30; P < 0.001), and acute kidney injury (aOR, 1.15; 95% CI, 1.07-1.24; P < 0.001). There were no significant differences in percutaneous coronary intervention, mechanical circulatory support, or defibrillator use ( P > 0.050).</p><p><strong>Conclusions: </strong>AF in MINOCA is associated with worse in-hospital outcomes, including mortality, sheart failure, acute kidney injury, and cardiogenic shock. AF may be a key prognostic marker in this population, warranting further research.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0391"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050832","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":"The Use of Global Longitudinal Strain to Detect Subclinical Reduction in Left Ventricular Pump Function: Erratum.","authors":"Ibtesam I El-Dosouky, Eman H Seddik, Shaimaa Wageeh","doi":"10.1097/HPC.0000000000000394","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000394","url":null,"abstract":"","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"24 3","pages":"e0394"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971611","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":"Abnormal Ankle-Brachial Index and Risk of Cardiovascular and all-cause mortality in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta-analysis.","authors":"Mohammad Hazique, Arihant Surana, Kunal N Patel, Jawad Basit, Jason M Lazar, Timir K Paul, M Chadi Alraies","doi":"10.1097/HPC.0000000000000396","DOIUrl":"10.1097/HPC.0000000000000396","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health concern associated with an elevated risk of cardiovascular (CV) and all-cause mortality. The ankle-brachial index (ABI), a noninvasive diagnostic tool, is widely recognized for detecting peripheral arterial disease. This meta-analysis aims to assess whether abnormally low or high ABI values independently predict CV and all-cause mortality in CKD patients, including those on hemodialysis.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Cochrane, and Google Scholar databases through September 2024 to identify studies on abnormal ABI and mortality outcomes in CKD patients with or without hemodialysis. Data was analyzed with random-effects models, and subgroup analyses evaluated variations by patient characteristics, region, sample size, and follow-up duration.</p><p><strong>Results: </strong>The analysis included 10 cohort studies comprising 13,378 participants. ABI values between 0.9 and 1.3 were defined as normal. Individuals with abnormally low ABI (<0.9) demonstrated a significantly higher incidence in CV mortality [hazard ratio (HR) = 2.23; confidence interval (CI), 1.75-2.83) and all-cause mortality (HR = 1.78; CI, 1.55-2.05). Those with high ABI ≥1.3 were associated with a 2.77-fold increase in CV mortality (HR = 2.77; CI, 1.74-4.41) and a 1.49 higher risk of all-cause mortality (HR = 1.49; CI, 1.09-2.02). Overall, abnormal ABI values were linked to a 1.74 higher risk of all-cause mortality (HR = 1.74; CI, 1.54-1.96) and a 2.34-fold increase in CV mortality (HR = 2.34; CI, 1.93-2.85). Subgroup analyses revealed higher mortality risks in hemodialysis patients compared with nondialysis CKD patients and in studies conducted in Asia.</p><p><strong>Conclusions: </strong>Abnormal ABI values show a U-shaped relationship with mortality, serving as strong predictors of CV and all-cause mortality in CKD patients, particularly those on hemodialysis. Since CV and all-cause mortality are high in CKD patients, these findings suggest that ABI measurement is a useful screening technique to assist in prognosticating such patients. Further studies are warranted to validate these findings and to better understand the prognostic utility of ABI across different CKD stages, including both dialysis-dependent and nondialysis CKD patients.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0396"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121000","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":"Performance of High-Sensitivity Troponin T Risk Stratification Strategies for 90-day Cardiac Death or Myocardial Infarction.","authors":"R Gentry Wilkerson, Nicklaus P Ashburn, Anna C Snavely, Brandon R Allen, Robert H Christenson, Michael Weaver, Xiaoxi Zhang, Troy E Madsen, Bryn E Mumma, Michael W Supples, Simon A Mahler","doi":"10.1097/HPC.0000000000000397","DOIUrl":"10.1097/HPC.0000000000000397","url":null,"abstract":"<p><strong>Background: </strong>Thirty-day performance of the high-sensitivity troponin T (hs-cTnT) European Society of Cardiology 0/1-hour (ESC 0/1-h) and \"one-and-done\" (hs-cTnT<limit of quantification) strategies are established. However, 90-day performance is unclear. Our objective was to evaluate the 90-day performance of these hs-cTnT strategies in a US cohort.</p><p><strong>Methods: </strong>A preplanned secondary analysis of a prospective multisite US cohort was conducted. Adults with chest pain were enrolled from 8 emergency departments (January 2017-September 2018). hs-cTnT measures (0- and 1-h) were used to classify patients by the ESC 0/1-h algorithm into rule-out, observation, and rule-in zones. Patients with 0-h measures <limit of quantification were considered ruled out by the one-and-done strategy. The primary outcome was adjudicated 90-day cardiac death or myocardial infarction (MI). Negative predictive value (NPV) for the primary endpoint and efficacy (proportion ruled out) were calculated for each strategy alone and in combination with the History, ECG, Age, Risk factor, and Troponin (HEART) score.</p><p><strong>Results: </strong>Among 1462 patients with a mean age of 57.6 ± 12.9 years, 46.4% (678/1462) were female, and 14.0% (205/1462) had cardiac death or MI at 90 days. One-and-done strategy efficacy was 32.8% (479/1462), and NPV was 99.0% [95% confidence interval (CI), 97.6-99.7]. Adding the HEART score decreased efficacy to 20.1% (293/1462) and increased NPV to 99.7% (95% CI, 98.1-100). ESC 0/1-h efficacy was 57.8% (826/1430) and NPV was 98.3% (95% CI, 97.2-99.1). Combined with a HEART score, NPV increased to 99.3% (95% CI, 98.0-99.9), but efficacy decreased to 30.8% (95% CI, 28.3-33.2).</p><p><strong>Conclusions: </strong>The one-and-done strategy and ESC 0/1-hour algorithm had modest rates of missed 90-day cardiac death or MI. Adding a HEART score improved safety but decreased efficacy.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0397"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650797","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":"Evaluating the Association of Clinical Cardiovascular Parameters and Metabolic Indices With Levels of Cystatin C in Early Middle Age.","authors":"Laith Ashour, Zeid Jarrar, Ghada Alzoubi, Samar Hamdan, Rima Heramas, Dima Alakhdar, Julie Abu Jeries, Areen Mishleb, Maher Marar, Layan Ayesh, Lina A Abu Sirhan","doi":"10.1097/HPC.0000000000000386","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000386","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of renal dysfunction requires population-based study. It is debatable in the literature whether cardiovascular metrics have an impact on cystatin C levels.</p><p><strong>Methods: </strong>Using public-use biomarkers data of The National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave 5 data, we tested, after adjusting for age (range: 32-42), anthropometrics (body mass index, waist circumference, and arm circumference), hemoglobin A1C, low-density lipoprotein, triglyceride, smoking, and sex, the association of 5 clinical cardiovascular measures (systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, and pulse rate) with cystatin C levels. Multiple linear regression analysis with a design-based approach was employed for data analysis after log-transformation of cystatin C levels.</p><p><strong>Results: </strong>Our findings showed that there was no significant association between cystatin C levels and any of the previously mentioned cardiovascular parameters in this age group (P > 0.05). However, there was a significant association between cystatin C levels and age [exponentiated estimate (EE) (percent increase per unit) = 1.21; 95% confidence interval (CI) = 0.97-1.103, P < 0.0001], body mass index and waist circumference (EE = 0.702; 95% CI = 0.7-0.705, P < 0.0001), triglycerides level (EE = 0.02; 95% CI = 0.0199-0.0201, P = 0.01), smoking status [EE (compared with nonsmokers) = 8.98, 95% CI = 8.95-9.01, P < 0.0001], and female sex [EE (compared with males) = -5.92; 95% CI = -5.94 to -5.89, P < 0.0001].</p><p><strong>Conclusions: </strong>Our findings clarify the impact of confounding factors, particularly age, on cystatin C levels. They also demonstrate how the significant correlation between cardiovascular parameters and cystatin C levels that were seen in earlier studies is largely affected by the age. Anthropometrics, age, lipid indices, and smoking should all be considered in clinical practice as possible reasons for increased cystatin C levels in otherwise healthy middle-aged individuals.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":"24 3","pages":"e0386"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972493","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":"Is Intravascular Ultrasound-Guided Angiography a Better Choice Than Angiography Alone for Patients With Acute Coronary Syndrome and Coronary Artery Disease? Unveiling the Efficacy and Safety of This Modern Imaging Method: A Systematic Review and Meta-Analysis.","authors":"Khaled M Harmouch, Mobeen Haider, Mohammad Hamza, Prakash Upreti, Yasemin Bahar, Mustafa Turkmani, Tea Rrapo, Nomesh Kumar, Manoj Kumar, Wasif Safdar, Yasar Sattar, Fnu Zafrullah, Abu Mhafouz, M Chadi Alraies","doi":"10.1097/HPC.0000000000000383","DOIUrl":"10.1097/HPC.0000000000000383","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary angiography has been an established standard for over 6 decades for percutaneous coronary interventions (PCIs), but its role is limited to assessing vascular lumen and anterograde flow. In the 1980s, intravascular ultrasonography (IVUS) gained traction in interventional cardiology for its advantages over angiography. Despite its precise evaluation of plaque burden and vessel wall structure for optimizing stent implantation, the literature reports varying outcomes on the efficacy and safety of IVUS-guided angiography in patients presenting with acute coronary syndrome or coronary artery disease. To address this discrepancy, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of utilizing IVUS versus angiography alone for PCI in these groups of patients.</p><p><strong>Methods: </strong>We conducted a comprehensive systematic review and meta-analysis to assess the efficacy and safety of IVUS-guided angiography in these patients. Electronic databases were searched, and 25 studies were included. Inclusion criteria are given as follows: (1) patients aged >18 years, (2) patients with acute coronary syndrome or coronary artery disease undergoing IVUS-guided PCI or angiography-guided PCI, and (3) randomized controlled trials. Exclusion criteria comprised observational, nonrandomized studies, case reports, clinical spotlights, and review articles. Studied outcomes included all-cause mortality, cardiac death, myocardial infarction, target lesion revascularization (TLR), need for coronary artery bypass graft, and stent thrombosis (ST).</p><p><strong>Results: </strong>Compared with angiography alone, IVUS-guided PCI demonstrated a significant reduction in cardiac death, TLR, and ST regardless of the follow-up period. No significant difference was observed between the 2 groups concerning all-cause mortality, and myocardial infarction regardless of the follow-up period, and the need for coronary artery bypass graft at 1-year follow-up.</p><p><strong>Conclusions: </strong>Compared with angiography-guided PCI, IVUS-guided PCI is associated with a lower incidence of cardiac death, TLR, and ST.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0383"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081072","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":"Clinical Profile and Outcomes of ST-Elevation Myocardial Infarction in Patients Under 45 Years.","authors":"Matheus Sacco Gomes, Otávio De Oliveira Marques, Gregório Furian Rossler Zanchi, Wagner Azevedo, Antonia Martins, Marina Nassif, Pedro Augusto Martins Barcelos, Pedro Castilhos de Freitas Crivelaro, Marco Wainstein, Guilherme Pinheiro Machado, Sandro Cadaval Gonçalves","doi":"10.1097/HPC.0000000000000403","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000403","url":null,"abstract":"<p><strong>Background: </strong>ST-segment elevation myocardial infarction (STEMI) remains a leading cause of global mortality. Although overall incidence is declining, this trend is less evident among younger individuals, emphasizing the need to better understand modifiable risk factors and clinical outcomes in this population.</p><p><strong>Objective: </strong>To analyze the clinical profile and outcomes of young patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) in a contemporary cohort.</p><p><strong>Methodology: </strong>This prospective cohort study included patients aged ≥18 years with confirmed STEMI treated with pPCI at a tertiary university hospital from March 2011 to January 2025. Patients were stratified into two groups: young (≤45 years) and older (>45 years). The primary outcome was in-hospital mortality. A two-sided significance level of p<0.05 was adopted.</p><p><strong>Results: </strong>A total of 2,050 patients were included; 191 (9.3%) were ≤45 years old (mean age: 39.9 years). Younger patients showed significantly lower in-hospital mortality (4.2% vs. 12.1%; p=0.001), shorter median length of stay (5 vs. 6 days; p=0.001), and lower incidence of long-term major adverse cardiovascular and cerebrovascular events (15.2% vs. 24.7%; p=0.003). They had higher prevalence of active smoking (57.1% vs. 40.6%; p<0.001), illicit drug use (18.3% vs. 10.0%; p<0.001), HIV infection (4.7% vs. 2.2%; p=0.003), and family history of coronary artery disease (24.2% vs. 12.4%; p<0.001).</p><p><strong>Conclusion: </strong>Young STEMI patients presented with fewer comorbidities and lower in-hospital mortality, but a higher prevalence of behavioral risk factors. These findings highlight the need for targeted preventive strategies and early detection to improve long-term outcomes.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151169","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}