Journal of the American Heart Association最新文献

{"title":"Social Isolation Is Associated With the Acceleration of Death and Incident Cardiovascular Disease in Adults With Chronic Kidney Disease.","authors":"Xiaoxi Zeng, Yifan Jiang, Zhongyu Liu, Huazhen Yang, Huan Song, Chunyang Li, Ping Fu","doi":"10.1161/JAHA.124.038951","DOIUrl":"10.1161/JAHA.124.038951","url":null,"abstract":"<p><strong>Background: </strong>Individuals with chronic kidney disease are at markedly increased risk of incident cardiovascular diseases (CVDs) and premature death. The impact of social isolation on adverse outcomes in chronic kidney disease remained understudied.</p><p><strong>Methods: </strong>This prospective cohort study included 13 090 individuals with chronic kidney disease from the UK Biobank. The exposure was social isolation categorized into 3 levels: least, moderately, and most isolated. Using accelerated failure time and restricted mean survival time analyses.</p><p><strong>Results: </strong>Compared with being least isolated, moderate and most isolation are associated with the acceleration of all-cause death with a time ratio of 0.87 (95% CI, 0.82-0.93; <i>P</i><0.001) and 0.76 (95% CI, 0.70-0.82; <i>P</i><0.001), respectively, and restricted mean survival time differences of 49.1 and 71.6 days within 10 years. We observed marginal association of moderate (time ratio, 0.93 [95% CI, 0.87-0.99]; <i>P</i>=0.039) and most isolation (time ratio, 0.87 [95% CI, 0.79-0.96]; <i>P</i>=0.005) with CVD. But the association was significant only for stroke, not for coronary artery disease. Based on pathways revealed by a directed acyclic graph constructed using the Bayesian network, we conducted inverse odds ratio-weighted mediation to decompose the total effect of social isolation on death, and found that CVD and sarcopenia mediated 21.8% (95% CI, 7.1-43.0) of the total effect of social isolation on death.</p><p><strong>Conclusions: </strong>Social isolation is associated with shortened survival and accelerates the onset of CVD in individuals with chronic kidney disease. Social support warrants attention in the prevention of death and CVD in these high-risk individuals.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038951"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Evidence Linking the Predicting Risk of Cardiovascular Disease Events Risk Score and Coronary Artery Calcium.","authors":"Aaron J Rhee, Krutika Pandit, Jeffrey S Berger, Eduardo Iturrate, Josef Coresh, Sadiya S Khan, Jung-Im Shin, Judith S Hochman, Harmony R Reynolds, Morgan E Grams","doi":"10.1161/JAHA.124.038991","DOIUrl":"10.1161/JAHA.124.038991","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038991"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiating Empagliflozin and Sacubitril/Valsartan Early After Acute Myocardial Infarction: Mechanistic Study.","authors":"Daina Martínez-Falguera, Júlia Aranyó, Gemma Ferrer-Curriu, Albert Teis, Elena Revuelta-Lopez, Idoia Diaz-Güemes, Marta Monguió-Tortajada, Edgar Fadeuilhe, Oriol Rodríguez-Leor, Francesc Poblador, Borja Montejo, Santiago Roura, Roger Villuendas, Axel Sarrias, Victor Bazan, Esther Jorge, Victoria Delgado, Francisco Rafael Jimenez-Trinidad, Montserrat Rigol, Neus Martinez-Micaelo, Núria Amigó, Antoni Bayes-Genis, Felipe Bisbal, Carolina Gálvez-Montón","doi":"10.1161/JAHA.124.040214","DOIUrl":"10.1161/JAHA.124.040214","url":null,"abstract":"<p><strong>Background: </strong>Empagliflozin and sacubitril/valsartan are established in heart failure treatment, but their effects after myocardial infarction (MI) are less clear. This study evaluated early empagliflozin initiation, with or without sacubitril/valsartan, on post-MI inflammation, oxidative stress, metabolism, fibrosis, cardiac function, and ventricular tachycardia (VT) risk in a pig model.</p><p><strong>Methods: </strong>A total of 24 of 30 pigs survived the MI procedure and were subsequently randomized to receive beta-blocker treatment alone (control-MI), beta-blocker+empagliflozin, or beta-blocker+empagliflozin+sacubitril/valsartan. Immune response, metabolic profile, and cardiac function were monitored. At 30 days after MI, programmed electrical stimulation and high-density mapping were performed and VT inducibility was assessed. Tissue samples were collected for cardiac inflammation, oxidative stress, and metabolic analyses.</p><p><strong>Results: </strong>Empagliflozin reduced circulating leukocytes at 2 and 15 days after MI (<i>P</i>=0.010 and <i>P</i>=0.050, respectively) and decreased C-C chemokine receptor 2+ monocytes at 15 days (<i>P</i>=0.049). Nitric oxide bioavailability increased in remote myocardium (<i>P</i>=0.059), along with cardioprotective liver lipids and collagen III in the myocardial scar (<i>P</i>=0.023). No effect on cardiac function or VT inducibility was observed at 30 days. With empagliflozin+sacubitril/valsartan, scar collagen I decreased (<i>P</i>=0.082), left ventricular compliance improved (<i>P</i>=0.029), electrophysiological remodeling improved (reduced border-zone corridors [<i>P</i>=0.006] and deceleration zones [<i>P</i>=0.008]), and VT inducibility decreased (<i>P</i>=0.025).</p><p><strong>Conclusions: </strong>In this pig model of nonreperfused MI treated with beta-blocker, early initiation of empagliflozin reduced inflammation, improved nitric oxide bioavailability, increased protective liver lipids, and modified scar composition without affecting cardiac function or VT risk. With empagliflozin+sacubitril/valsartan treatment, scar collagen I and VT inducibility declined and left ventricular remodeling was enhanced.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040214"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful or Uncomplicated Use of Drug-Coated Balloon Versus Drug-Eluting Stent Strategies for De Novo Culprit Lesions in Acute Coronary Syndromes: Insights from a Nationwide Registry in Japan.","authors":"Tomonori Takahashi, Kyohei Yamaji, Shun Kohsaka, Hideki Ishii, Yuichiro Mori, Yuetsu Kikuta, Tetsuzo Wakatsuki, Koji Yamaguchi, Daisuke Nishioka, Kenya Kusunose, Tetsuya Amano, Masataka Sata, Ken Kozuma","doi":"10.1161/JAHA.124.038071","DOIUrl":"10.1161/JAHA.124.038071","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials demonstrated that drug-coated balloon (DCB) was not inferior to drug-eluting stent (DES) for acute coronary syndrome (ACS). However, generalizability in clinical settings remains unclear. The present study compared the outcomes of DCB and DES strategies in percutaneous coronary intervention for ACS within a nationwide procedure-based registry.</p><p><strong>Methods and results: </strong>This was a retrospective analysis of a cohort study from a prospective, nationwide registry between January 2017 and December 2020 in Japan, focusing on patients with ACS who underwent DCB or DES for a single de novo lesion. Patients who required bailout stenting after treatment with DCB were excluded from the analysis. The 1-year incidence of all-cause mortality, cardiovascular death, noncardiovascular death, nonfatal ACS, stroke, and major bleeding events was compared. A subgroup analysis included lesion-based and ST-elevation myocardial infarction/non-ST-elevation ACS stratifications. Among 5212 propensity score-matched patients with ACS, no significant differences were observed in the 1-year incidence of all-cause mortality (4.5% versus 4.6%, hazard ratio [HR], 0.92 [95% CI, 0.72-1.19]); cardiovascular death (2.5% versus 2.5%, HR, 0.90 [95% CI, 0.64-1.26]); noncardiovascular death (2.0% versus 2.1%, HR, 0.96 [95% CI, 0.65-1.42]); or nonfatal ACS (1.7% versus 2.0%, HR, 1.04 [95% CI, 0.70-1.54]) between DCB and DES. DCB was associated with a higher incidence of stroke (0.8% versus 0.3%, HR, 2.33 [95% CI, 1.06-5.08]) and lower incidence of major bleeding events (1.4% versus 2.3%, HR, 0.65 [95% CI, 0.43-0.99]); however, these results were not reproduced in the subgroup analysis.</p><p><strong>Conclusions: </strong>The DCB strategy for successfully treated ACS cases achieved similar clinical outcomes to DES after 1 year. Further studies with an extended follow-up are needed to confirm these results.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038071"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy Cardiovascular Status Attenuates the Detrimental Association Between Osteosarcopenic Adiposity and Alzheimer's Disease-Related Dementia: A UK Biobank Cohort Study.","authors":"Wenxu Wang, Rui Ren, Honghao Yang, Jinguo Jiang, Xingyue Ye, Chenying Wang, Xiang Ji, Wen Li, Yuhong Zhao, Yang Xia, Difei Wang","doi":"10.1161/JAHA.125.041697","DOIUrl":"10.1161/JAHA.125.041697","url":null,"abstract":"<p><strong>Background: </strong>Body composition abnormalities are associated with the risk of Alzheimer's disease-related dementia (ADRD). However, the specific link between osteosarcopenic adiposity (OSA), cardiovascular health (CVH), and ADRD is underexplored. This study examined the association between OSA and ADRD to determine whether optimal CVH could modify this association.</p><p><strong>Methods: </strong>We analyzed data from 152 028 UK Biobank participants. OSA-related body composition abnormalities include low bone mineral density, low muscle mass/grip strength, and high body fat percentage. CVH was assessed using the Life's Essential 8 questionnaire. High and low CVH corresponded to the lowest and highest cardiovascular disease risks, respectively. The hazard ratios (HRs) and 95% CIs for ADRD were estimated using Cox proportional hazards models. A secondary analysis included 14 750 participants with brain magnetic resonance imaging data to explore the role of brain structure in the association between OSA and the incidence of ADRD.</p><p><strong>Results: </strong>After a median follow-up of 14.1 years, 2628 participants (1.73%) developed ADRD. Compared with participants with no body composition abnormalities, the adjusted HRs for ADRD risk for those with 1, 2, and 3 abnormalities were 1.04 (95% CI, 0.95-1.14), 1.17 (95% CI, 1.04-1.31), and 1.46 (95% CI, 1.11-1.92), respectively. We found a significant addictive interaction between CVH and abnormal body components, with a relative excess risk due to interaction (95% CI) of -1.34 (95% CI, -2.11 to -0.57). Gray matter in the hippocampus could mediate these associations, with a mediation proportion of 17.3% (<i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>OSA components are positively associated with the risk of ADRD. Maintaining optimal CVH status may mitigate ADRD risk in individuals with OSA.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041697"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of New-Onset Peripheral Artery Disease in Patients With Type 2 Diabetes Exposed to Sodium-Glucose Cotransporter-2 Inhibitors, Dipeptidyl Peptidase-4 Inhibitors, or Glucagon-Like Peptide-1 Agonists: A Population-Based Cohort Study.","authors":"Oscar Hou-In Chou, Zhiyao Luo, Cheuk To Skylar Chung, Jeffrey Chan, Huixian Li, Ishan Lakhani, Sharen Lee, Dawnie Ho Hei Lau, Qingpeng Zhang, Tong Liu, Wing Tak Wong, Bernard Man Yung Cheung, Gregory Y H Lip, Fung Ping Leung, Gary Tse, Jiandong Zhou","doi":"10.1161/JAHA.123.034175","DOIUrl":"10.1161/JAHA.123.034175","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2Is), dipeptidyl peptidase-4 inhibitors (DPP4Is), and glucagon-like peptide-1 receptor agonists have been associated with improved cardiovascular outcomes and prognosis. The comparative risks of new-onset peripheral artery disease (PAD) between these medications remain unknown. This real-world study compared the risks of PAD in patients exposed to SGLT2I and DPP4I.</p><p><strong>Methods and results: </strong>This was a retrospective population-based cohort study of patients with type 2 diabetes on either an SGLT2I or a DPP4I between January 1, 2015, and December 31, 2015, using a territory-wide database from Hong Kong. The primary outcome was new-onset PAD. The secondary outcomes were cardiovascular hospitalization, cardiovascular death, and all-cause death. Propensity score matching (1:1 ratio) using the nearest neighbor search was performed. Multivariable Cox regression with time-weighted variables was used to identify significant associations. A 3-arm analysis including the glucagon-like peptide-1 receptor agonist cohort was conducted. This cohort included 75 470 patients with type 2 diabetes (median age, 62.3±12.8 years; 55.79% men). The SGLT2I and DPP4I groups consisted of 28 753 patients and 46 717 patients, respectively. After matching, 186 and 256 patients had PAD in the SGLT2I and DPP4I groups, respectively, over a median follow-up of 5.6 years. SGLT2I use was associated with lower risks of PAD (hazard ratio [HR], 0.79 [95% CI, 0.66-0.93]) compared with DPP4I use after adjusting for demographics, comorbidities, medications, renal function, and glycemic tests. The association remained consistent regardless of sex, age, and other metabolic diseases. In the 3-arm analysis, the risk of PAD was not statistically different between SGLT2Is and glucagon-like peptide-1 receptor agonists (HR, 1.18 [95% CI, 0.52-2.68]). The results remained consistent in the competing risk and the sensitivity analyses.</p><p><strong>Conclusions: </strong>SGLT2I use among patients with type 2 diabetes was associated with lower risks of new-onset PAD and PAD-related outcomes when compared with DPP4Is after adjustments.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e034175"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of Atrioventricular Coupling Index in Cardiovascular Disease.","authors":"Shuxuan Qin, Li Zhang, Mengmeng Ji, Zhenni Wu, Yixia Lin, Qing He, Mingxing Xie, Yuman Li","doi":"10.1161/JAHA.125.041392","DOIUrl":"10.1161/JAHA.125.041392","url":null,"abstract":"<p><p>Atrioventricular coupling refers to the synchronized interaction between the atrial and ventricular phases of contraction and relaxation within the cardiac cycle. Atrioventricular coupling can be assessed by the left atrioventricular coupling index and right atrioventricular coupling index. These indices provide a comprehensive assessment of the functional interdependence between the atrial and ventricular chambers, and offer insights into cardiac performance beyond traditional markers. Atrioventricular coupling indices are critical for aiding in risk stratification and clinical decision-making, ultimately improving patient outcomes. This review focuses on the clinical utility of atrioventricular coupling in various cardiac pathologies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041392"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter 2 Inhibitors in Patients With Systemic Right Ventricles: Incrementally Building the Evidence Base.","authors":"William H Marshall, Curt J Daniels","doi":"10.1161/JAHA.125.043096","DOIUrl":"10.1161/JAHA.125.043096","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043096"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysregulated Tricarboxylic Acid Cycle Metabolism Is Associated With Right Ventricular Maladaptation in Pulmonary Vascular Disease.","authors":"Darin T Rosen, Todd M Kolb, Stephen C Mathai, Karthik Suresh, Rachel Damico, Steven Hsu, Ryan J Tedford, Anna R Hemnes, Jane A Leopold, Evelyn M Horn, Erika S Berman-Rosenzweig, Franz Rischard, Robert P Frantz, Serpil C Erzurum, Gerald J Beck, Nicholas S Hill, John Barnard, Samar Farha, Gabriele Grunig, Christine Jellis, Deborah H Kwon, Reena Mehra, Margaret M Park, W H Wilson Tang, Paul M Hassoun, Catherine E Simpson","doi":"10.1161/JAHA.124.041127","DOIUrl":"10.1161/JAHA.124.041127","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular (RV) maladaptation to elevated pulmonary afterload is the primary determinant of outcomes in pulmonary artery (PA) hypertension; however, the pathobiological mechanisms underlying RV decompensation remain poorly understood.</p><p><strong>Methods: </strong>We performed global untargeted metabolomics on plasma from 55 patients who underwent gold-standard RV-PA coupling measurements using multibeat pressure volume loop assessment in a single-center cohort and from 1027 patients with coupling surrogate measurements in a larger multicenter cohort, the PVDOMICS (Pulmonary Vascular Disease Phenomics) study. Age and sex-adjusted linear regression was performed to identify associations between metabolites and coupling metrics. Additionally, we performed a metabolic flux analysis using gene expression data from RV tissue in an independent cohort of 32 patients. Partial least squares-discriminant analysis was used to identify metabolites and reactions characteristic of the decompensated RV.</p><p><strong>Results: </strong>RV-PA coupling was negatively associated with tricarboxylic acid (TCA) cycle intermediate levels. Specifically, plasma α-ketoglutarate and fumarate were significantly associated with all coupling metrics in both cohorts. Metabolic flux analysis indicated that decompensated RVs exhibited aberrant TCA cycle activity, including reduced acetyl coenzyme A entry and increased lactate elimination, suggesting a shift from the TCA cycle toward glycolysis at the RV tissue level.</p><p><strong>Conclusions: </strong>We identify an association between circulating TCA cycle intermediate levels and RV-PA uncoupling in 2 independent cohorts, and dysregulated TCA cycle metabolism in decompensated PA hypertension RVs, suggesting that aberrant TCA cycle metabolism could represent a hallmark of RV maladaptation in PA hypertension. Further study of this pathway is warranted to develop novel biomarkers of RV function or RV-targeted therapies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041127"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Use and Clinical Significance of Initial Triple Versus Double Therapy After Percutaneous Coronary Intervention for Myocardial Infarction in Patients With Atrial Fibrillation.","authors":"Dae Yong Park, Bianca McLean, Zafer Akman, Darrick K Li, Golsa Babapour, Michael G Nanna","doi":"10.1161/JAHA.124.038589","DOIUrl":"10.1161/JAHA.124.038589","url":null,"abstract":"<p><strong>Background: </strong>Patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) have traditionally received triple therapy (dual antiplatelet therapy and anticoagulation). More recent randomized trial evidence supports a strategy of double therapy (anticoagulant plus single antiplatelet agent), albeit after a brief triple therapy course. The safety of initiating double therapy immediately post-PCI remains unclear.</p><p><strong>Methods and results: </strong>This study analyzed real-world prescribing patterns and outcomes of immediate double therapy versus initial triple therapy in patients with atrial fibrillation post-PCI using the Vizient Clinical Database. Patients with atrial fibrillation undergoing PCI for myocardial infarction (2016-2023) were categorized into 2 groups: triple therapy (aspirin, P2Y12 [purinergic receptor P2Y, G-protein coupled, 12 protein] inhibitor, and anticoagulant) or double therapy (anticoagulant and 1 antiplatelet agent) on day 1 post-PCI. The primary outcome was in-hospital mortality. Secondary outcomes included stent thrombosis, major bleeding, intracranial hemorrhage, and net clinical adverse events. Multivariable logistic regression and inverse probability of treatment weighting were used to compare outcomes. Among 29 226 patients, 16.3% received immediate double therapy on day 1 post-PCI, whereas 83.7% received triple therapy. Adjusted analyses showed no significant differences in in-hospital mortality (9.4% versus 9.2%, adjusted odds ratio [aOR], 1.05 [95% CI, 0.93-1.18]), major bleeding, intracranial hemorrhage, or net clinical adverse events. However, immediate double therapy was associated with higher odds of stent thrombosis (1.1% versus 0.8%; aOR, 1.48 [95% CI, 1.08-2.03]), particularly in patients with ST-segment-elevation myocardial infarction (2.0% versus 1.3%; aOR, 1.46 [95% CI, 1.001-2.13]).</p><p><strong>Conclusions: </strong>Immediate double therapy post-PCI is frequently used and appears safe for most patients with atrial fibrillation. Further studies are needed to identify high-risk subgroups, including those with ST-segment-elevation myocardial infarction, who may benefit from an initial short course of triple therapy.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038589"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}