Critical Pathways in Cardiology最新文献

{"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}

{"title":"Pathway for the Diagnosis and Management of Pericardial Disease: Contemporary Perspective.","authors":"Sanjay Sivalokanathan, Eyal Herzog, Syed Waqas Haider, Edgar Argulian","doi":"10.1097/HPC.0000000000000432","DOIUrl":"10.1097/HPC.0000000000000432","url":null,"abstract":"<p><p>Pericardial disease represents a diverse clinical spectrum, including acute pericarditis, pericardial effusion, cardiac tamponade, effusive-constrictive pericarditis (CP), and CP, which vary significantly in presentation, urgency, and management. Recent consensus guidelines from the European Society of Cardiology and the American College of Cardiology have enhanced clinical phenotyping, multimodal imaging techniques, and targeted immunomodulatory therapies; however, their implementation in clinical practice remains variable. We introduce our updated pathway-based framework that structures diagnosis and treatment around 5 key clinical scenarios: chest pain, hemodynamic collapse, dyspnea, incidental pericardial effusion, and right-sided heart failure. Each scenario guides a systematic process of risk stratification, tiered diagnostic evaluation, and phenotype-specific therapy. In cases of acute pericarditis, management employs a 3-tier escalation approach, with interleukin-1 inhibitors (rilonacept, anakinra) as the preferred escalation for inflammatory phenotypes unresponsive to nonsteroidal anti-inflammatory drugs and colchicine. Cardiac magnetic resonance imaging is integral to phenotyping, utilizing late gadolinium enhancement and T2-STIR sequences to inform treatment escalation. Management of pericardial effusion is standardized through a validated drainage scoring system that considers etiology, size, and echocardiographic hemodynamics. CP is classified into 3 subtypes: transient/inflammatory, effusive-constrictive, and chronic/fixed, each with a distinct management pathway, reserving surgical pericardiectomy at specialized centers for fibrotic or medically refractory cases. This pathway consolidates current evidence into a reproducible clinical framework designed to standardize care, enhance diagnostic precision, and facilitate shared decision-making among multidisciplinary pericardial disease teams.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0432"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296611","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":"Management and Outcomes of Postmyocardial Infarction Left Ventricular Pseudoaneurysm: A Case-level Systematic Review.","authors":"Chaitanya Karimanasseri, Daler Rahimov, Divya Sankisa, Nayeem Nasher, Manal Mustafa, Adeeba Allimulla, Samuel Vizzeswarapu, Konstadinos A Plestis, John W Entwistle, Joseph E Bavaria, Vakhtang Tchantchaleishvili","doi":"10.1097/HPC.0000000000000424","DOIUrl":"10.1097/HPC.0000000000000424","url":null,"abstract":"<p><p>Left ventricular pseudoaneurysm (LVPA) is a rare mechanical complication of acute myocardial infarction (MI) associated with significant mortality. Given the paucity of available data in the literature, we sought to pool existing evidence to better understand the current management strategies and outcomes. Electronic search was performed in February 2025 to identify all studies reporting management of post-MI LVPA. A total of 158 reports, with a total of 159 patients, were included. Patient-level data were extracted for analysis. A total of 159 patients were included in the analysis. The median age was 65 years [Interquartile range (IQR), 57-75], and 70% (106/159) of patients were male. The most frequent site of MI was the inferior wall (31.4%, 49/156), and the most common method of MI management was thrombolysis (49%, 64/131). The median time from MI to presentation signs/symptoms of LVPA was 21 days (IQR, 0-152). The most common LVPA location was the anterior/apical wall (27.7%, 44/159). Sixty-six percent of patients (105/159) underwent surgical repair, while 22% of patients (35/159) were managed medically, and 5.7% (9/159) of patients underwent transcatheter repair. In-hospital/30-day mortality was 10% (16/159), with operative mortality after surgical repair of 4.8% (5/105). Mortality from reoperative surgery was 18.8% (3/16) as opposed to 2.2% (2/89) in patients without redo sternotomy ( P = 0.004). Periprocedural mortality among patients treated with transcatheter intervention occurred in a single case (11.1%), involving a patient with prior coronary artery bypass grafting. At a median follow-up of 6 months (IQR, 1-12), overall survival was 86.1% (137/159). Surgery remains the standard therapy of LVPA, with acceptable operative risk; however, reoperative sternotomy carries a higher surgical risk. In carefully selected patients, percutaneous repair may serve as a viable alternative to surgery.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0424"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346615","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":"Predicting Risk of Cardiovascular Disease Events (PREVENT) Versus Pooled Cohort Equations for 10-Year Atherosclerotic Cardiovascular Disease Risk Prediction: A Meta-Analysis.","authors":"Roopeessh Vempati, Meet Patel, John Gallagher, Shaunak Mangeshkar, Mohammad Hamza, Nezar Nahlawi, Khaled Elnaggar, Jawad Basit, Geetha Krishnamoorthy, M Chadi Alraies","doi":"10.1097/HPC.0000000000000431","DOIUrl":"10.1097/HPC.0000000000000431","url":null,"abstract":"<p><strong>Background: </strong>Accurate estimation of atherosclerotic cardiovascular disease (ASCVD) risk underpins primary prevention strategies. The pooled cohort equations (PCE), long used in US guidelines, face criticism for risk overestimation and reliance on race-based coefficients. In 2023, the American Heart Association introduced the race-neutral Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, which integrate metabolic, renal, and socioeconomic factors to improve calibration and clinical relevance. However, comparative evidence has not been systematically synthesized.</p><p><strong>Methods: </strong>PubMed, EMBASE, Scopus, and Google Scholar were searched (January 2010-September 2025) for studies directly comparing PREVENT and PCE within the same adult cohorts. Eligible studies reported discrimination (area under the curve/C-statistic), calibration, or reclassification metrics. Random-effects models using restricted maximum-likelihood pooled standardized mean differences. Heterogeneity, influence, and publication bias were assessed using I 2 , leave-one-out analyses, and Egger's test.</p><p><strong>Results: </strong>Eight studies, including 2,296,156 adults without baseline CVD and 5-15 years of follow-up, were analyzed. No significant difference in discrimination was observed between PREVENT and PCE (pooled standardized mean difference 0.93; 95% confidence interval, -1.56 to 3.41; P = 0.465). Heterogeneity was substantial (I 2 = 100%), though leave-one-out analyses confirmed robustness. Subgroup analyses by ASCVD versus broader CVD outcomes showed consistent findings. Egger test revealed no small-study effects ( P = 0.352). Across individual studies, several studies reported differences in calibration and risk reclassification between PREVENT and PCE.</p><p><strong>Conclusions: </strong>PREVENT and PCE exhibit similar discrimination for 10-year ASCVD risk despite marked heterogeneity. PREVENT may offer differences in calibration and risk reclassification across populations. Ongoing validation across diverse populations is warranted to confirm generalizability and long-term clinical utility across healthcare systems.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0431"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340547","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":"A systematic review and meta-analysis comparing the clinical outcomes of the Watchman FLX versus Watchman 2.5 device for transcatheter left atrial appendage occlusion in patients with atrial fibrillation.","authors":"Meerab Ali Khan, Ayesha Muhammad, Hunain Shahbaz, Abbas Khan, Khawaja Arham Jawaid, Talha Riaz, Khizran Attaullah, Airij Noor, Saeeda Zahid, Mariam Azam Warya, Usama Khan, Mazhar Ali, Saja Mohammed Taher Al-Zamili, Bilal Aslam, Ayleen Umar, Abdullah Abdullah, Zaryab Bacha","doi":"10.1097/HPC.0000000000000434","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000434","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter left atrial appendage occlusion (LAAO) prevents cardioembolic stroke in patients with non-valvular atrial fibrillation who cannot tolerate long term anticoagulation. Whether the second-generation Watchman FLX confers superior clinical outcomes over the first-generation Watchman 2.5 remains incompletely characterized.</p><p><strong>Methods: </strong>We performed a PRISMA 2020-compliant systematic review and meta-analysis of studies comparing Watchman FLX with Watchman 2.5. Three electronic databases were searched through April 2026. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were derived using DerSimonian-Laird random-effects models. Nine prespecified outcomes were analyzed: procedural success, device-related embolism, device-related thrombosis (DRT), major bleeding, pericardial effusion, all-cause mortality, any stroke, ischemic stroke, and length of hospital stay (LOHS).</p><p><strong>Results: </strong>Seven observational cohort studies enrolling 131,728 patients (Watchman FLX: n = 54,023; Watchman 2.5: n = 77,705) were included. All studies received Newcastle-Ottawa Scale scores of 8-9 (high quality). The Watchman FLX demonstrated significantly higher procedural success (RR 1.02 [1.02-1.02]; p < 0.00001) and significant reductions in pericardial effusion (RR 0.33 [0.27-0.41]; p < 0.00001), device-related embolism (RR 0.38 [0.23-0.60]; p < 0.0001), all-cause stroke (RR 0.75 [0.65-0.86]; p < 0.0001), ischemic stroke (RR 0.81 [0.69-0.96]; p = 0.01), major bleeding (RR 0.65 [0.53-0.81]; p < 0.0001), and all-cause mortality (RR 0.54 [0.37-0.78]; p = 0.001). DRT showed a directional but non-significant trend toward reduction (RR 0.33 [0.09-1.20]; p = 0.09). LOHS was not reliably estimable (I² = 87%).</p><p><strong>Conclusions: </strong>The Watchman FLX is associated with significantly superior safety and efficacy outcomes relative to the Watchman 2.5 across the principal clinical domains of transcatheter LAAO. These findings are observational and hypothesis-generating rather than definitive evidence of device superiority; all comparisons reflect temporal and contextual differences inherent to sequential device eras and should be interpreted with caution. These results support the design of prospective, contemporaneously enrolled comparative studies and may inform future guideline deliberations.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563201","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 Consequences of Withdrawing Guideline-Directed Medical Therapy in Heart Failure with Improved Ejection Fraction: A Systematic Review and Meta-Analysis.","authors":"Tooba Rehman, Muhammad Aqib Faizan, Muhammad Waqas, Fatima Saeed, Ensieh Sadat Mansouri, Jaivardhan A Menon, Moiuz Chaudhri, Mian Muhammad Salman Aslam, Zainab Humayun, Mrunalini Dandamudi, Abbas Ali, Edgardo Kaplinsky, Juliana Giorgi, Alejandro Barbagelata","doi":"10.1097/HPC.0000000000000430","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000430","url":null,"abstract":"<p><p>Heart failure with reduced ejection fraction (HFrEF) and heart failure with improved ejection fraction (HFimpEF) represent dynamic states modifiable by pharmacologic therapy. Guideline Directed Medical Therapy (GDMT) reduces morbidity and mortality in HFrEF, but the necessity and safety of continued GDMT after recovery in HFimpEF remains uncertain and the safety of stopping therapy in these patients is unclear. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing GDMT withdrawal with continuation in HFimpEF. Five studies involving 4,773 patients were included. Withdrawal of comprehensive GDMT, defined as discontinuing two or more than two drug classes of GDMT, significantly increased the risk of relapse of adverse cardiac remodelling (RR = 9.35, p = 0.02). Critically, stopping renin-angiotensin-aldosterone system inhibitors (RAASi) was associated with a higher risk of all-cause mortality (RR=1.50, 95%CI=1.09_2.07; p=0.01). In contrast, withdrawal of beta-blockers alone showed no significant effect on mortality. These findings highlight that the recovery of HFimpEF is often contingent on continued GDMT. Withdrawal, particularly of multiple agents or RAASi carries substantial risk of relapse and death. Our findings mandate a paradigm of continued, lifelong GDMT for vast majority of HFimpEF patients as they remain vulnerable despite apparent recovery, and continuation of GDMT is essential to prevent relapse and improve survival. Selective withdrawal may only be considered in highly selected patients under strict monitoring until reliable predictors of durable recovery are established.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563211","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":"Sex Differences in Immune Checkpoint Inhibitor-related Cardiotoxicity: A Propensity Score-matched Cohort Study.","authors":"Abdul Rasheed Bahar, Yasemin Bahar, Paawanjot Kaur, Nagasai Yalavarthi, Ali Awad, Shaheena Raheem, Aiden Abidov","doi":"10.1097/HPC.0000000000000433","DOIUrl":"https://doi.org/10.1097/HPC.0000000000000433","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) are widely used in cancer therapy but may cause cardiovascular immune-related adverse events (irAEs) with substantial morbidity and mortality. The impact of biological sex on ICI-associated cardiotoxicity remains incompletely defined in real-world populations.</p><p><strong>Objectives: </strong>To evaluate sex-based differences in cardiovascular immune-related adverse events following immune checkpoint inhibitor therapy.</p><p><strong>Methods: </strong>We conducted a retrospective, propensity score-matched cohort study using the TriNetX global research network. Adults initiating ICI therapy were stratified by biological sex and matched 1:1 on demographics, cardiovascular comorbidities, and baseline cardiotoxic therapies. The primary outcome was incident myocarditis at 6 months, 1 year, and 2 years. Secondary outcomes included arrhythmias, conduction abnormalities, and cardiomyopathies. Relative risks (RRs) with 95% confidence intervals (CIs) were reported.</p><p><strong>Results: </strong>The matched cohort included 60,116 pairs of female and male patients with good overall covariate balance. Females had a lower risk of myocarditis at 6 months (RR 0.76; 95% CI 0.63-0.91; P=0.004), 1 year (RR 0.81; 95% CI 0.68-0.95; P=0.011), and 2 years (RR 0.81; 95% CI 0.69-0.94; P=0.008), along with lower risks of atrial fibrillation, ventricular arrhythmias, high-degree atrioventricular block, ischemic cardiomyopathy, and dilated cardiomyopathy. In contrast, females had a higher risk of Takotsubo cardiomyopathy across all time points.</p><p><strong>Conclusions: </strong>ICI-associated cardiotoxicity is associated with sex-related differences, with higher rates of myocarditis and arrhythmic events in males and increased occurrence of Takotsubo cardiomyopathy in females. These findings suggest differences in cardiovascular risk patterns and highlight the need for further study to better understand their clinical relevance.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473174","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":"Maximum Troponin As an Independent Predictor of 30- and 90-day Mortality in Type 2 Myocardial Infarction.","authors":"Krunal Shukla, Prattyak Mukhopadhyay, Mohammed Ruzieh","doi":"10.1097/HPC.0000000000000423","DOIUrl":"10.1097/HPC.0000000000000423","url":null,"abstract":"<p><strong>Background: </strong>Type 2 myocardial infarction (Type 2 MI) is increasingly recognized among older adults and individuals with multiple comorbidities. We evaluated the association between maximum troponin levels and 30- and 90-day all-cause mortality using both continuous values and clinically meaningful thresholds.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV database. Our analysis focused on patients with Type 2 MI, with maximum troponin level being the primary exposure of interest. We examined troponin's association with both 30-day and 90-day mortality, treating it as a continuous variable and categorizing it into thresholds: 10×, 100×, and 1000× the upper limit of normal (ULN), using 0.04 ng/mL (99th percentile of ULN) as the reference group. 1398 patients met our inclusion criteria.</p><p><strong>Results: </strong>Maximum troponin was an independent predictor of 30-day mortality and 90-day mortality after adjusting for confounders ( P = 0.018, P = 0.016, respectively). Compared with the reference group (<0.04 ng/mL), the relative risks of 30-day mortality were 1.39 [95% confidence intervals (CI), 0.89-2.17] for 10× ULN, 1.72 (95% CI, 1.10-2.71) for 10-100× ULN, 1.85 (95% CI, 1.16-2.95) for 100-1000× ULN, and 2.45 (95% CI, 1.31-4.57) for >1000× ULN. A similar pattern was seen for 90-day mortality, with relative risks of 1.28 (95% CI, 0.89-1.96), 1.76 (95% CI, 1.22-2.69), 1.63 (95% CI, 1.09-2.54), and 2.07 (95% CI, 1.05-3.35), respectively.</p><p><strong>Conclusions: </strong>Higher troponin levels are independently associated with increased short- and intermediate-term mortality in Type 2 MI, supporting the potential use of troponin thresholds for risk stratification in this high-risk population.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0423"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594645","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":"Efficacy and Safety of Mavacamten and Aficamten in Obstructive and Nonobstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis.","authors":"Muhammad Ibrahim, Aamna Kashif, S M Washaqul Arfin, Manahil Mubeen, Aroosa Zafar, Rahul Balach, Arsalan Ahmed, Muzammil H Musani, Stephen J Greene, Gregg C Fonarow, Muhammad Umer Sohail","doi":"10.1097/HPC.0000000000000418","DOIUrl":"10.1097/HPC.0000000000000418","url":null,"abstract":"<p><p>Cardiac myosin inhibitors (CMIs) are novel, disease-modifying therapies for hypertrophic cardiomyopathy (HCM). This meta-analysis evaluates the efficacy of CMIs versus placebo in patients with HCM. A systematic review and meta-analysis of randomized controlled trials involving adults with obstructive and nonobstructive HCM was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered on PROSPERO. Databases including PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through September 2025. Random-effects models were performed using standardized mean differences for biomarker and WMDs for echocardiographic parameters. Risk ratios (RRs) were calculated for dichotomous outcomes, with 95% confidence intervals. Seven randomized controlled trials, comprising 1406 patients (732 CMI; 674 placebo), were included. CMIs significantly improved resting [WMD: -57.27 mm Hg (-63.05, -51.49); P < 0.001] and post-Valsalva left ventricular outflow tract gradient [WMD: -55.87 mm Hg (-63.05, -51.49); P < 0.001]. Left ventricular ejection fraction decreased modestly [WMD: -4.74% (-7.22, -2.26); P = 0.0002]. CMIs increased the likelihood of ≥1 New York Heart Association class improvement [RR: 1.94 (1.37, 2.74); P < 0.001] and Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score [WMD: +6.60 points (3.84, 9.35); P < 0.001]. N-terminal pro B-type natriuretic peptide [WMD: -13.35 (-18.04, -8.67); P < 0.001] and cardiac troponin I [WMD: -11.90 (-15.07, -8.73); P < 0.001] declined. Peak oxygen uptake showed no overall change [WMD: +0.64 mL/kg/min (-0.18, 1.47); P = 0.12]. CMIs increased adverse events [RR: 1.07 (1.02, 1.13); P = 0.008], particularly hypertension [RR: 2.19 (1.06, 4.53); P = 0.03]. CMIs improve hemodynamics, functional status, and biomarkers in HCM with an acceptable safety profile and hold promise as disease-modifying therapy, though long-term outcomes require confirmation.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0418"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120509","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":"Sirolimus-Coated Versus Paclitaxel-Coated Balloons for Coronary Artery Disease: A Grade Assessed Systematic Review and Meta-Analysis.","authors":"Fatima Sajjad, Asad Iqbal Khattak, Kanza Farhan, Ayesha Arshad, Abdullah Afridi, Muhammad Abdullah Ali, Iqra Shahid, Zeeshan Imtiaz, Hammad Naveed, Umama Alam, Fathimathul Henna, Zoya Riaz, Fazia Khattak, Saad Ahmed Waqas, Raheel Ahmed","doi":"10.1097/HPC.0000000000000415","DOIUrl":"10.1097/HPC.0000000000000415","url":null,"abstract":"<p><p>Despite advances in percutaneous coronary procedures, in-stent restenosis remains a significant challenge. Although sirolimus- and paclitaxel-coated balloons are promising alternatives, their comparative safety and efficacy remain uncertain. PubMed, Embase, and Cochrane databases were searched using relevant keywords from inception until August 2025. A total of 11 studies (7 randomized controlled trials and 4 observational cohort studies) were included, comprising 3633 participants overall. The primary outcomes assessed were target lesion revascularization and target lesion failure. Meanwhile, the Secondary outcomes included stent thrombosis, all-cause mortality, myocardial infarction, major adverse cardiovascular events, survival, binary restenosis, and angiographic endpoints (acute gain, diameter stenosis, in-segment late lumen loss, in-lesion late lumen loss, and in-segment minimal lumen diameter). Interstudy heterogeneity was assessed using I ² and X ² statistics ( I ²>50% = significant heterogeneity). Interstudy heterogeneity was low for most outcomes, including all primary clinical endpoints, with moderate heterogeneity observed only for select angiographic measures (notably in-segment late lumen loss and diameter stenosis). Statistical analysis was conducted using R software and RStudio (version 4.4.2), with a P value of < 0.05 indicating statistical significance. This meta-analysis examined studies that compared paclitaxel-coated balloon (PCB) versus standard balloon [sirolimus-coated balloon (SCB)] angioplasty. Regarding primary outcomes, there were no notable variations in target lesion failure [risk ratio (RR), 1.08, 95% CI, 0.90-1.29, P = 0.36] or target lesion revascularization (RR, 1.16, 95% CI, 0.98-1.37, P = 0.08). With all aggregated estimates being nonsignificant, secondary outcomes such as stent thrombosis, all-cause mortality, myocardial infarction, major adverse cardiovascular events, and survival were similar between groups. Angiographic endpoints revealed no discernible variations in late lumen loss (in-lesion and in-segment), acute gain, or diameter stenosis. Nonetheless, the SCB group's minimal lumen diameter was significantly smaller than that of the PCB group (MD, -0.08 mm, 95% CI, -0.14 to -0.01, P = 0.02). In treating coronary in-stent restenosis, SCB and PCBs show similar overall safety and effectiveness; lesion-specific angiographic variations indicate that customized selection may improve patient outcomes.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":"e0415"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985907","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}