Journal of the American Heart Association最新文献

{"title":"Mitral Valve Transcatheter Edge-to-Edge Repair or Medical Therapy in Systolic Heart Failure: A Meta-Analysis of Randomized Trials.","authors":"Rohin K Reddy, David Koeckerling, Gregg W Stone, James P Howard, Yousif Ahmad","doi":"10.1161/JAHA.124.039285","DOIUrl":"https://doi.org/10.1161/JAHA.124.039285","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039285"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477884","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":"Twenty-Four-Month Outcomes of Heparin-Bonded Covered Stents and Drug-Coated Balloon Angioplasty in Femoropopliteal Artery Occlusion.","authors":"Yuhao Lin, Yaowen Chang, Jing Wang, Huijun Yuan, Feng Zhang, Ruipeng Zhang, Jianjun Quan, Jian Dong, Yang Han, Longlong Cong, Lin Yang","doi":"10.1161/JAHA.124.039384","DOIUrl":"https://doi.org/10.1161/JAHA.124.039384","url":null,"abstract":"<p><strong>Background: </strong>The clinical outcomes of comparing covered stents (CSs) and drug-coated balloons (DCBs) angioplasty in femoropopliteal artery occlusion remain unknown. This study aimed to evaluate the midterm efficacy of CS and DCB procedures in patients with FPO.</p><p><strong>Methods: </strong>All 194 patients were divided into CS (94 patients) and DCB (100 patients) groups in this multicenter retrospective study. The primary end point was primary patency at 24 months, and the secondary end points included freedom from clinically driven target lesion revascularization, limb salvage, major adverse events, and overall survival rates. Propensity score matching analysis was performed to reconfirm the main end points.</p><p><strong>Results: </strong>Compared with the patients in the DCB group, those in the CS group had a lower prevalence of smoking (54.3% versus 74.0%, <i>P</i>=0.004) and diabetes (38.3% versus 66.0%, <i>P</i><0.001) before propensity score matching. Compared with the DCB procedure, the CS procedure resulted in a significantly greater primary patency at 24 months (74.4% versus 55.8%, <i>P</i>=0.019), with comparable primary patency at 12 months; similar results were obtained after matching. However, there was no difference in terms of clinically driven target lesion revascularization, limb salvage, major adverse events, or overall survival rates. Subgroup analyses confirmed the superior clinical patency of CS in patients with diabetes (<i>P</i>=0.010) and proximal reference vessel diameter ≥5.0 mm (<i>P</i>=0.038). A baseline ankle brachial index <0.40 was likely to be an independent risk factor for restenosis, and a postprocedural ankle brachial index ≥0.80 and the CS used (hazard ratio [HR], 0.54 [95% CI, 0.32-0.91], <i>P</i>=0.021) were potential protective factors for restenosis after multivariate analysis.</p><p><strong>Conclusions: </strong>Compared with the DCB procedure, the CS procedure resulted in greater primary patency at 24 months in complicated femoropopliteal artery occlusion lesions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039384"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477890","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":"Income-Level and Immigrant Status Are Associated With Discontinuation of Evidence-Based Secondary Prevention Therapies After Myocardial Infarction.","authors":"Joel Ohm, Kevin Ma, Sara Freyland, Ali Yari, Tomas Jernberg, Per Svensson","doi":"10.1161/JAHA.124.041781","DOIUrl":"https://doi.org/10.1161/JAHA.124.041781","url":null,"abstract":"<p><strong>Background: </strong>Mechanisms for worse prognosis after myocardial infarction in low socioeconomic status are unclear. We therefore investigated the association between socioeconomic status and discontinuation of evidence-based secondary prevention drug therapies.</p><p><strong>Methods: </strong>All patients with a first-ever myocardial infarction, on treatment with a statin (n=60 717), antithrombotic therapy (n=65 862), or a renin-angiotensin-aldosterone-system inhibitor (n=51 486) at the routine 1-year visit in SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) between January 2006 and mid-2020 were included in this population-based nationwide cohort study. Individual-level socioeconomic status was measured by disposable income quintile, region of birth, and educational level. Outcomes were discontinuation (>180 days without a new prescription claim) of statins, antithrombotic therapies, and renin-angiotensin-aldosterone-system-inhibitors. Bias-minimized multivariable adjusted hazard ratios (aHRs) were estimated during follow-up until December 2020.</p><p><strong>Results: </strong>Discontinuation occurred more often in the lowest versus highest income quintile for statins (aHR, 1.25 [95% CI, 1.20-1.31]), antithrombotic therapy (aHR, 1.26 [95% CI, 1.20-1.32]), and renin-angiotensin-aldosterone-system inhibitors (aHR, 1.32 [95% CI, 1.26-1.39]). Discontinuation of statins was more frequent among immigrants (versus nonimmigrants) born in other Nordic (aHR, 1.24 [95% CI, 1.17-1.32]), other European (aHR, 1.40 [95% CI, 1.33-1.47]), Asian (aHR, 1.45 [95% CI, 1.36-1.56]), and other world regions (aHR, 1.63 [95% CI, 1.45-1.84]). Associations between immigrant background and discontinuation of antithrombotic therapies and renin-angiotensin-aldosterone-system inhibitors were even stronger. Lower (versus tertiary) educational level was inversely associated with discontinuation of secondary prevention drug classes.</p><p><strong>Conclusions: </strong>Despite Swedish universal health care, discontinuation of evidence-based drugs post myocardial infarction is strongly associated with disposable income and immigrant background. Further study on strategies to improve adherence in low socioeconomic status post myocardial infarction is warranted.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041781"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477883","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":"Association Between Physical Activity Dose and Mental Health Among Stroke Survivors.","authors":"Ajith Kumar Vemuri, Seyyed Sina Hejazian, Alireza Vafaei Sadr, Aishwarya Chandrasekaran, Sasan Bahrami, Shouhao Zhou, Jonathan Hakun, Christopher Sciamanna, Vida Abedi, Ramin Zand","doi":"10.1161/JAHA.124.041189","DOIUrl":"https://doi.org/10.1161/JAHA.124.041189","url":null,"abstract":"<p><strong>Background: </strong>Although physical activity correlates with reduced depressive symptoms among survivors of stroke, how frequency, intensity, and duration of physical activity relate to mental health is unknown. This study aims to find the association of physical activity doses recommended in 2011, 2014, and 2021 American Heart Association/American Stroke Association guidelines with mental health burden (number of days of poor mental health). Analysis was expanded to find the optimal dose linked to mental health burden.</p><p><strong>Methods: </strong>We used data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, a nationally representative survey. The mental health burden between guideline-adherent and nonadherent groups was compared. Propensity score matching was used to balance the 2 groups with respect to sociodemographic factors and comorbidities. The relative difference in mental health burden between the groups is reported. The impact of duration, frequency, and intensity was analyzed using nonlinear regression, adjusting for potential confounders. We further performed a comparative analysis among survivors of myocardial infarction.</p><p><strong>Results: </strong>Survivors of stroke who adhered to 2011, 2014, and 2021 guidelines had 0.6, 0.8, and 0.3 fewer days of poor mental health, with relative differences of 11.1%, 14.8%, and 5.8%, respectively. Among survivors of stroke adhering to 2014 guidelines (3-4 sessions/week, 40 minutes/session), younger (18-64) individuals showed greater relative differences in mental health burden at 15.7%. For those adhering to 2021 guidelines (4 moderate 10-minute or 2 vigorous 20-minute sessions), older (≥65) individuals had higher relative differences at 11.1%. Regression analysis showed that the optimal dose is 4 to 6 weekly sessions of moderate physical activity, each lasting 45 minutes.</p><p><strong>Conclusions: </strong>The findings suggest that physical activity doses recommended in 2011, 2014, and 2021 American Heart Association/American Stroke Association guidelines are associated with lower mental health burden. Furthermore, the amount of physical activity associated with lower mental health may vary by subpopulations (eg, age). Randomized control trials are needed to validate the optimal dose.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041189"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477875","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":"Endoplasmic Reticulum Stress-Induced triggering Receptor Expressed on Myeloid Cells 2 (TREM2) Downregulation Exacerbates Platelet Activation and Myocardial Infarction in Patients With Coronary Artery Disease.","authors":"Xiaowen Wu, Guanxing Pan, Lin Chang, Qian Liu, Yangyang Liu, Wei Zhang, Yifan Guo, Ge Zhang, Haoxuan Zhong, Zhiyong Qi, Jianjun Zhang, Ruyi Xue, She Chen, Hu Hu, Jianzeng Dong, Si Zhang, Zhongren Ding","doi":"10.1161/JAHA.124.041220","DOIUrl":"https://doi.org/10.1161/JAHA.124.041220","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease is characterized by chronic immune-inflammation, excessive endoplasmic reticulum (ER) stress, and platelet hyperactivity; however, whether there is a signaling hub linking these events remains unclear. Here, we identified that TREM2 (triggering receptor expressed on myeloid cells 2), an important pattern recognition receptor of the innate immune system, may serve as one such hub.</p><p><strong>Methods: </strong>TREM2 expression and ER stress were assessed in platelets. Transcriptional repression of TREM2 by excessive ER stress was evaluated using luciferase assay, chromatin immunoprecipitation, and electrophoretic mobility shift assay. The effects of TREM2 deficiency on platelet function, mouse FeCl₃-induced mesenteric arterial thrombosis, and myocardial infarction were explored. A TREM2-activating antibody was also evaluated for its antiplatelet, antithrombotic, and cardioprotective potential against myocardial infarction.</p><p><strong>Results: </strong>We found that platelets express TREM2, and its expression is reduced in platelets from patients with coronary artery disease. Excessive ER stress downregulated TREM2 through the CHOP (C/EBP-homologous protein)-C/EBPα axis. TREM2 deficiency enhanced platelet activation in response to adenosine diphosphate, collagen, and CRP (collagen-related peptide). TREM2 deficiency exacerbated mouse mesenteric arterial thrombosis and aggravated experimental myocardial infarction. Furthermore, a TREM2-activating antibody inhibited platelet activation, reduced thrombosis, and alleviated experimental myocardial infarction. Mechanistically, the TREM2/DAP12 (DNAX activating protein of 12 kDa)/SHIP1 (Src homology 2 domain-containing inositol 5-phosphatase) axis negatively regulated platelet activation through reducing phosphatidylinositol (3,4,5)-trisphosphate levels and inhibiting Akt phosphorylation. Sphingosine-1-phosphate was identified as a physiological TREM2 agonist.</p><p><strong>Conclusions: </strong>TREM2 integrates ER stress, immune inflammation, and platelet function. ER stress-induced TREM2 downregulation contributes to platelet hyperactivation in coronary artery disease, suggesting TREM2 activation as a novel therapeutic target.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041220"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477879","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":"Femoral Vessel Occlusion Enhances Cardiac and Cerebral Perfusion in a Porcine Model of Cardiac Arrest.","authors":"Joshua Y Kim, Benjamin Usry, Maren L Downing, Samuel W Seigler, Heather Holman, Jennie H Kwon, Kristi Helke, Rupak Mukherjee, Jeffrey A Jones, Kristen M Quinn","doi":"10.1161/JAHA.124.037413","DOIUrl":"https://doi.org/10.1161/JAHA.124.037413","url":null,"abstract":"<p><strong>Background: </strong>Closed chest compressions during cardiopulmonary resuscitation (CPR) mechanically circulate blood to the organs during cardiac arrest, yet cardiac arrest remains among the most fatal diseases, with a mortality rate that exceeds 85% to 90% globally. Novel methodologies to improve organ perfusion, particularly in resource-restricted settings, are overdue. This study evaluated the efficacy of external femoral vessel occlusion (FVO) during CPR in a large mammal model.</p><p><strong>Methods: </strong>Thirteen adult Yorkshire pigs were instrumented with vascular and electrophysiologic monitoring lines. Hemodynamic measures and cardiac and cerebral perfusion in the pre- and postarrest conditions were quantified via fluorescent microspheres infused into the circulation. Control (n=7) animals underwent routine CPR, whereas experimental (n=6) animals received CPR and FVO via external compression to the femoral vessels during the entirety of the 30-minute resuscitative phase. The primary outcome was mean arterial pressure, and secondary outcomes included cerebral and cardiac perfusion.</p><p><strong>Results: </strong>During native heart function, external FVO demonstrated a significant increase in mean arterial pressure (73±3 versus 62±2 mm Hg, <i>P</i><0.001). During cardiac arrest, animals undergoing CPR with FVO had a significantly higher mean arterial pressure compared with CPR alone (49±9 versus 32±3 mm Hg, <i>P</i><0.001). CPR with FVO significantly increased cardiac (181 versus 80 mean fluorescence intensity, <i>P</i>=0.014) and cerebral perfusion (119 versus 27 mean fluorescence intensity, <i>P</i><0.001).</p><p><strong>Conclusions: </strong>CPR with FVO significantly increased mean arterial pressure, cardiac perfusion, and cerebral perfusion over CPR alone. These findings suggest FVO may represent a novel adjunctive strategy and therapeutic opportunity to enhance cerebral and cardiac perfusion, thereby decreasing cardiac arrest morbidity and mortality.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037413"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477880","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":"Venous Hematocrit: Caveats to Informing Blood Volume and Relative Risk in Chronic Heart Failure.","authors":"Wayne L Miller","doi":"10.1161/JAHA.125.041343","DOIUrl":"https://doi.org/10.1161/JAHA.125.041343","url":null,"abstract":"<p><strong>Background: </strong>Venous hematocrit (vHct) is commonly used to inform blood volume (BV) status and stratify cardiovascular risk. However, vHct defines a percentage of red blood cells (RBCs) to total BV; therefore, similar vHcts can reflect significantly different absolute BVs and RBC mass/plasma volume profiles. This analysis explores how quantitative measures of BV enhance vHct reliability as a biomarker in heart failure.</p><p><strong>Methods: </strong>A retrospective analysis was undertaken in 395 patients stratified by vHcts reflecting clinically heart failure-relevant cut points (35% and 40%). BV was quantitated by the indicator-dilution methodology using iodinated-131 labeled albumin. Kaplan-Meier analyses compared outcomes.</p><p><strong>Results: </strong>Quantitative absolute BVs on average did not differ between vHct subgroups above or below cut points; however, the distribution of RBC mass and plasma volume profiles varied significantly. A normal BV profile was measured in approximately one third of cohort patients and BV hypervolemia in 58%, driven largely by plasma volume expansions (72% of cohort), all with similar distributions above and below cut points. In contrast, profiles of deficits in RBC mass (anemia) and excess (erythrocythemia) were more frequent below and above cut points, respectively, but not exclusively, with 14% of patients demonstrating contrasting RBC mass profiles. Kaplan-Meier analyses provided aggregate support for vHct to stratify heart failure-related outcomes but do not account for misclassified patients.</p><p><strong>Conclusions: </strong>VHcts lack capacity to discriminate absolute BVs or the variability in RBC mass and plasma volume profiles above or below cut points. Therefore, quantitative BV measurements are key to adding specificity to individual vHct values, which permits reliable identification of BV status, assignment of appropriate risk, and guidance in management.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041343"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477891","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":"Comparative Efficacy and Safety of Colchicine and Anti-Interleukin-1 Agents in Recurrent Pericarditis: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Muhammad Ehsan, Alveena Batool Syed, Biah Mustafa, Jibran Ikram, Muhammad Hammad Khan, Paul C Cremer, Massimo Imazio, Tom Kai Ming Wang, Allan L Klein","doi":"10.1161/JAHA.125.041007","DOIUrl":"https://doi.org/10.1161/JAHA.125.041007","url":null,"abstract":"<p><strong>Background: </strong>The management of recurrent pericarditis includes colchicine and anti-interleukin-1 agents, given the limited efficacy and adverse effects of NSAIDs and corticosteroids. We conducted a pairwise and network meta-analysis to evaluate the efficacy and safety of colchicine and anti-interleukin-1 agents in recurrent pericarditis.</p><p><strong>Methods: </strong>We conducted a comprehensive search on various databases to retrieve relevant randomized controlled trials. Pairwise meta-analyses were performed in R using the exact Mantel-Haenszel method. We also performed a network meta-analysis with a colchicine group as the comparator.</p><p><strong>Results: </strong>A total of 6 randomized controlled trials were included in the meta-analysis. The risk of pericarditis recurrence was significantly decreased by colchicine (risk ratio [RR], 0.46 [95% CI, 0.37-0.58]) and anti-interleukin-1 agents (RR, 0.12 [95% CI, 0.03-0.54]) compared with placebo or standard therapy. Colchicine significantly decreased the risk of treatment failure (RR, 0.42 [95% CI, 0.31-0.57]) and pericarditis-related rehospitalization (RR, 0.26 [95% CI, 0.10-0.70]) but did not have a significant impact on the risk of adverse events (RR, 1.06 [95% CI, 0.31-3.62]). Anti-interleukin-1 agents were associated with a significantly increased risk of adverse events (RR, 1.88 [95% CI, 1.60-2.21]). The network meta-analysis showed that anti-interleukin-1 agents were associated with a greater reduction in pericarditis recurrence than colchicine (RR, 0.27 [95% CI, 0.11-0.67]), with no significant difference with respect to adverse events (RR, 1.77 [95% CI, 0.88-3.57]).</p><p><strong>Conclusions: </strong>Both colchicine and anti-interleukin-1 agents are effective in reducing the risk of recurrent pericarditis. Anti-interleukin-1 agents are associated with more frequent nonserious adverse events, but evidence on serious adverse events remains inconclusive.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041007"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477877","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":"Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST-Segment-Elevation Myocardial Infarction: A Quasi-Experimental Study.","authors":"Shuduo Zhou, Siwei Xie, Binquan You, Dingcheng Xiang, Weiyi Fang, Michael G Trisolini, Kenneth A Labresh, Sidney C Smith, Zhi-Jie Zheng, Yinzi Jin, Feng Liu, Yong Huo","doi":"10.1161/JAHA.125.041995","DOIUrl":"https://doi.org/10.1161/JAHA.125.041995","url":null,"abstract":"<p><strong>Background: </strong>Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy compared with onsite fibrinolytic therapy (O-FT) for ST-segment-elevation myocardial infarction when delivered promptly. However, the contemporaneous data to inform the comparative benefits of primary PCI versus O-FT, especially in developing countries, have been largely understudied.</p><p><strong>Methods: </strong>We used data from the National Chest Pain Center Program (NCPCP), the largest nationwide registry in China, including patients with ST-segment-elevation myocardial infarction treated with primary PCI or O-FT from January 2016 to December 2022. Patients were matched using propensity scores, and the PCI-related delay was defined as the difference between the observed door-to-wiring time and the door-to-needle time. Mortality outcomes were assessed at different delay intervals (<60 minutes, 60-90 minutes, >90 minutes). Subgroup analyses were conducted based on age, infarction location, and Killip classification.</p><p><strong>Results: </strong>In 19 334 matched patients, primary PCI demonstrated a significant mortality benefit over O-FT when PCI-related delays were <60 minutes (2.34% versus 6.01%). However, this advantage diminished when delays exceeded 90 minutes. The critical threshold at which PCI lost its mortality benefit was identified as 119.51 minutes (door-to-wiring time - door-to-needle time). Subgroup analyses showed that older patients, patients with anterior infarction, and those with a higher Killip class appeared to have lower equipoise thresholds.</p><p><strong>Conclusions: </strong>Primary PCI offers a mortality benefit compared with O-FT in patients with timely treated ST-segment-elevation myocardial infarction, but treatment delays can mitigate this benefit. In settings with prolonged treatment delays, immediate fibrinolysis may be a more effective strategy. Treatment decisions should incorporate both patient characteristics and health care system constraints to optimize ST-segment-elevation myocardial infarction outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041995"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477876","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":"Reduced Incidence of Aortic Dissection in Patients With Type 2 Diabetes Treated With Sodium Glucose Transporter 2 Inhibitors.","authors":"Chi-Jung Chung, Hsin-Ying Lu, Mu-Chi Chung, Laing-You Wu, Chieh Huo, Li-Kuo Kuo, Chun-Chieh Liu, Chih-Pin Chuu","doi":"10.1161/JAHA.124.040260","DOIUrl":"https://doi.org/10.1161/JAHA.124.040260","url":null,"abstract":"<p><strong>Background: </strong>Inhibitors for sodium-glucose transport protein 2 (SGLT2) are being used widely in recent years to treat patients with type 2 diabetes (T2D). Studies demonstrated that SGLT2 inhibitors exhibit protective effect for certain cardiovascular diseases. However, no study has explored the effect of SGLT2 inhibitors on risk of aortic dissection in patients with T2D.</p><p><strong>Methods: </strong>We extracted and retrospectively analyzed the data of all patients with T2D from Taiwan National Health Institution databases between May 1, 2016, and December 31, 2021. Patients with T2D taking DPP4 (dipeptidyl peptidase 4) inhibitors were included for comparison to exclude glucose lowering effect on aortic dissection. In this cohort, 242 563 patients received SGLT2 inhibitors (T2D-SGLT2i), and 376 062 patients received DPP4 inhibitors (T2D-DPP4i). The inverse probability of treatment weighting statistical method was performed, which avoids sample loss due to matching. The hazard ratios (HRs) and 95% CIs for these patients with T2D were calculated using multivariate Cox models to approximate the associations.</p><p><strong>Results: </strong>The overall aortic dissection incidence per 100 000 patient-years was 14.83 for patients with T2D-SGLT2i and 29.56 for patients with T2D-DPP4i. Patients with T2D-SGLT2i were associated with a lower risk of aortic dissection as compared with patients with T2D-DPP4i after the adjustment of potential risk factors and comorbidity. Subgroup analysis indicated that use of SGLT2 inhibitor lowers the risk of aortic dissection in some subgroups of patients with T2D.</p><p><strong>Conclusions: </strong>Our study suggested that use of SGLT2 inhibitors correlated with lower risk of aortic dissection.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040260"},"PeriodicalIF":5.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477885","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}