Journal of the American Heart Association最新文献

{"title":"Incremental Prognostic Value of Echocardiography Measures of Right Ventricular Systolic Function in Patients With Chronic Heart Failure.","authors":"Francesco Gentile, Michela Chianca, Lorenzo Bazan, Paolo Sciarrone, Vlad Chubuchny, Claudia Taddei, Elisa Poggianti, Claudio Passino, Michele Emdin, Alberto Giannoni","doi":"10.1161/JAHA.124.038616","DOIUrl":"https://doi.org/10.1161/JAHA.124.038616","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid annular plane systolic excursion (TAPSE), Doppler tissue imaging-derived tricuspid lateral annular systolic wave velocity (S'), and right ventricular fractional area change (RV-FAC) are the most widely used echocardiographic measures of right ventricular systolic function. This study aimed to compare the prognostic value of TAPSE, S', and RV-FAC in a large cohort of patients with chronic heart failure.</p><p><strong>Methods: </strong>Consecutive outpatients with heart failure and left ventricular ejection fraction <50% on guideline-recommended therapies undergoing echocardiography were followed up for the end point of cardiac and all-cause death.</p><p><strong>Results: </strong>Among 1590 patients (71±12 years, 77% men, left ventricular ejection fraction 34%±9%), 202 (13%) died from cardiac causes during a median follow-up of 28 (interquartile range, 14-40) months. According to the recommended cut points for TAPSE (<17 mm), S' (<9.5 cm/s), or RV-FAC (<35%), right ventricular systolic dysfunction was found in 37%, 40%, and 35% of patients, respectively, with 21%, 31%, and 33% of discordant cases comparing TAPSE versus S', TAPSE versus RV-FAC, and S' versus RV-FAC. Both TAPSE <17 mm and RV-FAC <35% were more accurate than S' <9.5 cm/s in predicting the risk of cardiac death (<i>P</i><0.001), and their combination showed incremental prognostic power (<i>P</i><0.001). Adding S' to the combination of TAPSE and RV-FAC did not provide further incremental value (<i>P</i>=0.145). Similar findings were obtained when all-cause death was considered as the end point.</p><p><strong>Conclusions: </strong>In patients with chronic heart failure and left ventricular ejection fraction <50%, TAPSE, and RV-FAC are more accurate than S' in predicting the risk of cardiac and all-cause death. Considering both RV-FAC and TAPSE provides incremental prognostic value.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038616"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450864","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":"Atrial Fibrillation Treatment Pathway in the Emergency Department Reduces Median 30-Day Health Service Charges.","authors":"Rafat Mahmood, Tiffany Armbruster, Wanting Jin, Allysha Choudhury, Lindsey Rosman, Anthony J Mazzella, Quefeng Li, Kevin Biese, Sally C Stearns, Anil K Gehi","doi":"10.1161/JAHA.124.038756","DOIUrl":"https://doi.org/10.1161/JAHA.124.038756","url":null,"abstract":"<p><strong>Background: </strong>The economic burden of atrial fibrillation (AF) continues to increase. AF treatment pathways have been shown to reduce avoidable admissions, but the effects on health care costs are not understood. This study sought to assess the impact of an AF treatment pathway on health service charges and emergency department (ED) discharge rates.</p><p><strong>Methods: </strong>An AF treatment pathway was implemented at 7 hospital EDs in North Carolina between 2017 and 2020. Thirty-day health service charges were calculated for ED visits, hospitalizations, and outpatient clinic appointments. A quasi-experimental design was used to assess changes in health service charges and ED discharge rates following implementation of the AF treatment pathway. Adjusted quantile and negative binomial regressions were used to analyze changes in median 30-day health service charges and discharge rates from the ED, respectively.</p><p><strong>Results: </strong>Among 12 504 patients that met eligibility for study inclusion (preperiod: n=3893; postperiod: n=8611), implementation of the AF treatment pathway significantly reduced 30-day health service charges (preperiod: $11 922; postperiod: $9219; <i>P</i><0.001). In adjusted models, implementation of the AF treatment pathway was associated with an $834 decrease in median 30-day health service charges (95% CI, -$1630 to $-37; <i>P</i>=0.04). Additionally, the adjusted predicted probability of ED discharge increased from 65.3% to 70.0% after the AF treatment pathway implementation, a 4.7 percentage point increase (95% CI, 1.4-8.0; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>The implementation of an AF treatment pathway in the ED was associated with a decrease in median 30-day health service charges and an increase in ED discharge rate for patients presenting with AF.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038756"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450655","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":"Cardiovascular Outcomes With Icosapent Ethyl by Baseline Low-Density Lipoprotein Cholesterol: A Secondary Analysis of the REDUCE-IT Randomized Trial.","authors":"Rahul Aggarwal, Deepak L Bhatt, Ph Gabriel Steg, Michael Miller, Eliot A Brinton, Richard L Dunbar, Steven B Ketchum, Jean-Claude Tardif, Fabrice M A C Martens, Christie M Ballantyne, Michael Szarek, R Preston Mason","doi":"10.1161/JAHA.124.038656","DOIUrl":"https://doi.org/10.1161/JAHA.124.038656","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of icosapent ethyl among patients with very well-controlled baseline low-density lipoprotein cholesterol (LDL-C) is unknown.</p><p><strong>Methods: </strong>In this post hoc analysis of the REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial) randomized clinical trial, statin-treated patients with high cardiovascular risk, elevated triglycerides (135-499 mg/dL), and baseline LDL-C of 41 to 100 mg/dL were included. Patients were randomized to icosapent ethyl (2 g twice daily) or placebo and then post hoc stratified by baseline LDL-C (<55 mg/dL versus ≥55 mg/dL). The primary composite end point included cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina.</p><p><strong>Results: </strong>Among 8175 patients with baseline LDL-C data, 7117 (87.1%) had LDL-C ≥55 mg/dL and 1058 (12.9%) had LDL-C <55 mg/dL. In patients with LDL-C <55 mg/dL, the rate of the primary composite end point was lower in the icosapent ethyl group (16.2% versus 22.8%) than in the placebo group (hazard ratio [HR], 0.66 [95% CI, 0.50-0.87]; absolute risk reduction, 6.6%; <i>P</i>=0.003). Among patients with LDL-C ≥55 mg/dL, a primary composite end point event occurred in a lower proportion of patients in the icosapent ethyl group (17.4% versus 21.9%) than in the placebo group (HR, 0.76 [95% CI, 0.69-0.85]; absolute risk reduction, 4.5%; <i>P</i><0.0001). No significant interaction was observed between baseline LDL-C and treatment group (<i>P</i> for interaction=0.40). Findings were consistent among secondary cardiovascular end points and in sensitivity analyses.</p><p><strong>Conclusions: </strong>Among statin-treated patients with elevated triglycerides and high cardiovascular risk, icosapent ethyl reduced the rate of cardiovascular end points irrespective of baseline LDL-C, including among eligible patients with optimal LDL-C control.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01492361.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038656"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450656","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":"Inactive Matrix Gla Protein and Cardiovascular Outcomes: The Multi-Ethnic Study of Atherosclerosis.","authors":"Ashley A Berlot, Xueyan Fu, M Kyla Shea, Russell Tracy, Matthew Budoff, Ryung S Kim, Mahim Naveed, Sarah L Booth, Jorge R Kizer, Anna E Bortnick","doi":"10.1161/JAHA.124.036459","DOIUrl":"https://doi.org/10.1161/JAHA.124.036459","url":null,"abstract":"<p><strong>Background: </strong>MGP (matrix Gla protein) inhibits arterial calcification. Higher inactive MGP, in its dephosphorylated-uncarboxylated (dp-uc) form, is positively associated with vascular calcification, possibly portending adverse cardiovascular events. The objective of this study was to determine the association of dp-ucMGP with incident cardiovascular disease (CVD) events and mortality in MESA (Multi-Ethnic Study of Atherosclerosis).</p><p><strong>Methods: </strong>MESA is a prospective cohort study of 45- to 84-year-old individuals enrolled between 2000 and 2002 with adjudicated outcomes through 2019. Dp-ucMGP was measured at baseline in n=2663 participants with cardiac computed tomography at Exams 1 (2000-2002) and 5 (2010-2012). Age-stratified Cox proportional hazard models were used to assess dp-ucMGP with risk of all CVD (mean follow-up 16±4 years), hard CVD (17±3 years), hard coronary heart disease (17±3 years), and all-cause mortality (18±2 years).</p><p><strong>Results: </strong>The youngest age quartile (45- to 53-years-old) with higher dp-ucMGP levels (520-2934 pmol/L) had an increased risk of all CVD (hazard ratio [HR], 3.05 [95% CI, 1.58-5.90], <i>P</i>=0.001), hard CVD (HR, 2.85 [95% CI, 1.30-6.23], <i>P</i>=0.009), hard coronary heart disease (HR, 3.79 [95% CI, 1.31-10.95], <i>P</i>=0.014), and all-cause mortality (HR, 2.73 [95% CI, 1.19-6.30], <i>P</i>=0.018) compared with those with dp-ucMGP levels between 150 and 519 pmol/L in maximally adjusted models.</p><p><strong>Conclusions: </strong>Younger individuals 45 to 53 years old with elevated dp-ucMGP levels (≥520 pmol/L) had an increased risk of incident CVD, coronary heart disease, and all-cause mortality. No association was seen in older adults. Additional studies are needed to better delineate the relationship of inactive MGP with incident CVD, coronary heart disease, and all-cause mortality.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036459"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450863","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":"Population Impact of Using the PREVENT Equations to Guide the Management of Stage 1 Hypertension in the United States.","authors":"Yelena Drexler, Eugene Yang, Robert A Mesa, Jacklyn Samaha, Tali Elfassy","doi":"10.1161/JAHA.124.038915","DOIUrl":"https://doi.org/10.1161/JAHA.124.038915","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038915"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450941","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":"Unraveling Novel Subsets of Lymphocytes Involved in Sac Expansion in the Tertiary Lymphoid Structure Within an Abdominal Aortic Aneurysm.","authors":"Itaru Hosaka, Ippei Ikegami, Takuma Mikami, Tatsuya Sato, Toshifumi Ogawa, Kei Mukawa, Marenao Tanaka, Keisuke Endo, Yukinori Akiyama, Akihito Ohkawa, Junji Nakazawa, Tsuyoshi Shibata, Tomohiro Nakajima, Yutaka Iba, Chikara Shiiku, Satoshi Sumino, Ryuji Koshima, Kenichi Takano, Shingo Ichimiya, Nobuyoshi Kawaharada, Masato Furuhashi","doi":"10.1161/JAHA.124.040279","DOIUrl":"https://doi.org/10.1161/JAHA.124.040279","url":null,"abstract":"<p><strong>Background: </strong>Chronic inflammation is involved in the development of abdominal aortic aneurysm (AAA). A tertiary lymphoid structure (TLS) within vascular lesions has recently been focused on for its role in modulation of inflammation in local tissues. We aimed to elucidate the relationships between TLS and pathophysiology of AAA.</p><p><strong>Methods: </strong>Abdominal aortic samples obtained from 37 patients with AAA (men/women: 34/3, age: 72.8±9.9 years) and 15 autopsied patients who died from non-aortic events (men/women: 11/4, age: 65.5±9.8 years) were investigated.</p><p><strong>Results: </strong>TLSs in AAA lesions were confirmed by focal infiltration of CD3-positive cells surrounding germinal center-like structures containing CD20-positive cells between the tunica adventitia and tunica media layers. The formation of a TLS was significantly more prevalent in AAA patients than in autopsied patients. The number of TLSs in AAA lesions was positively correlated with sac diameter (r=0.357, <i>P</i>=0.035) and the amount of intraluminal thrombosis (r=0.466, <i>P</i>=0.005). T cells and B cells were predominant cellular populations among CD45⁺ cells in AAA lesions. There was a significantly positive correlation between the proportions of interfollicular T follicular helper (CD3⁺CD4⁺CD45RA^-CXCR5⁺PD-1⁺) cells and double negative B (CD3^-CD19⁺IgD^-CD27^-) cells, and they were positively correlated with sac diameter, intraluminal thrombosis, and serum lipids. Deposited single-cell RNA-sequencing data for AAA showed that T follicular helper cells and double negative B cells were associated with lipid metabolism, T cell activation/proliferation and inflammation.</p><p><strong>Conclusions: </strong>The formation of a TLS in AAA lesions is associated with sac diameter and intraluminal thrombosis in connection with interfollicular T follicular helper cells and double negative B cells, which may contribute to the pathophysiology of AAA and might be novel therapeutic targets for the development of AAA.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040279"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450924","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":"Intravenous Thrombolysis in Cervical Artery Dissection-Related Stroke: A Nationwide Study.","authors":"Liqi Shu, Elizabeth Lee, Thalia S Field, Xiaofan Guo, Nils Henninger, Zafer Keser, Muhib Khan, Eva A Mistry, Thanh N Nguyen, James E Siegler, Lukas Strelecky, Daniel M Mandel, Christoph Stretz, Karen L Furie, Shadi Yaghi","doi":"10.1161/JAHA.124.039662","DOIUrl":"https://doi.org/10.1161/JAHA.124.039662","url":null,"abstract":"<p><strong>Background: </strong>Although intravenous thrombolysis (IVT) is safe and effective in populations with general stroke, its impact on cervical artery dissection-related acute ischemic stroke (CeAD-AIS) remains unclear. This retrospective study used the National Inpatient Sample to compare outcomes in patients with CeAD-AIS treated with and without IVT.</p><p><strong>Methods: </strong>We included adult patients with concurrent CeAD and AIS diagnoses (<i>International Classification of Diseases, Tenth Revision</i> [<i>ICD-10</i>], codes) hospitalized from 2016 to 2019. The primary outcome was home discharge; safety outcomes included inpatient death and intracerebral hemorrhage. We performed survey-weighted multivariable logistic regressions comparing IVT versus no IVT, followed by interaction analyses to examine effect modifications based on age, medical history, stroke severity, carotid artery involvement, and endovascular treatment.</p><p><strong>Results: </strong>Between 2016 and 2019, 1360 (12.1%) of 11 285 patients with CeAD-AIS received IVT. IVT-treated patients had higher median National Institutes of Health Stroke Scale scores (median [interquartile range], 8 [4-17] versus 3 [1-11]; <i>P</i><0.001). Adjusted analyses showed IVT was associated with higher odds of home discharge (adjusted odds ratio [OR], 1.40 [95% CI, 1.01-1.92]; <i>P</i>=0.042), but not with inpatient death (adjusted OR, 1.29 [95% CI, 0.76-2.20]; <i>P</i>=0.347) or intracerebral hemorrhage (adjusted OR, 0.69 [95% CI, 0.32-1.48]; <i>P</i>=0.341). Stroke severity (<i>P</i> for interaction=0.001) and carotid artery involvement (<i>P</i> for interaction=0.021) significantly modified IVT's effect on home discharge, with IVT being associated with an increased likelihood of home discharge in patients with moderate to severe strokes (National Institutes of Health Stroke Scale score >4) and carotid artery involvement.</p><p><strong>Conclusions: </strong>IVT improves the likelihood of home discharge in patients with CeAD-AIS without increasing the risk of inpatient death or intracerebral hemorrhage.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039662"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450935","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":"Modified Rankin Scale at 90 Days Versus National Institutes of Health Stroke Scale at 24 Hours as Primary Outcome in Acute Stroke Trials.","authors":"Johanna M Ospel, Scott Brown, Salome Bosshart, Alexander Stebner, Kazutaka Uchida, Andrew Demchuk, Jeffrey L Saver, Philip White, Keith W Muir, Diederik W J Dippel, Charles B L M Majoie, Tudor G Jovin, Bruce C V Campbell, Peter J Mitchell, Serge Bracard, Francis Guillemin, Michael Hill, Mayank Goyal","doi":"10.1161/JAHA.124.037752","DOIUrl":"https://doi.org/10.1161/JAHA.124.037752","url":null,"abstract":"<p><strong>Background: </strong>We investigate whether the National Institutes of Health Stroke Scale (NIHSS) at 24 hours could serve as a primary outcome in acute ischemic stroke trials, and whether combining 90-day modified Rankin Scale (mRS) and 24-hour NIHSS in a hierarchical outcome could enhance detection of treatment effect, using endovascular treatment (EVT) as an exemplary study intervention.</p><p><strong>Methods: </strong>This was a post hoc analysis of pooled data from 7 randomized EVT trials. Twenty-four-hour NIHSS as a surrogate outcome for 90-day mRS was assessed in a causal mediation model. A 7-point ordinal NIHSS score was generated by grouping 24-hour NIHSS, including death as a separate category (\"ordinal\" NIHSS). EVT effect sizes and sample sizes required for detecting EVT benefit with 80% power were compared when using granular 24-hour NIHSS, ordinal 24-hour NIHSS, 90-day mRS, and a hierarchical outcome (win ratio) that combines 90-day mRS and 24-hour NIHSS.</p><p><strong>Results: </strong>A total of 1720 patients were included. Twenty-four-hour NIHSS mediated the association between EVT and 90-day mRS and met criteria for a useful surrogate outcome. Effect sizes were highest and sample sizes required to detect EVT benefit smallest for the win ratio approach (228), followed by 90-day mRS (240) and ordinal 24-hour NIHSS (242). In patients with baseline NIHSS <10 and ≥25, ordinal 24-hour NIHSS resulted in the highest effect size.</p><p><strong>Conclusions: </strong>Twenty-four-hour NIHSS is a useful surrogate outcome for 90-day mRS in patients with acute ischemic stroke undergoing EVT, with a similar EVT effect size compared with 90-day mRS. It could potentially enhance detection of EVT benefit in patients with very low or high baseline NIHSS. An ordered hierarchical outcome could improve detection of EVT treatment effect.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037752"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450940","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":"BIO4LIFE-Surgical Aortic Valve Replacement Followed by Valve-in-Valve Transcatheter Aortic Valve Replacement for Lifetime Management of Aortic Valve Disease: Panacea or Fairytale?","authors":"Michel Pompeu Sá, Nilay K Patel, Nathaniel B Langer, Arminder S Jassar, Jordan P Bloom","doi":"10.1161/JAHA.124.038464","DOIUrl":"https://doi.org/10.1161/JAHA.124.038464","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038464"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450640","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":"Variation in Likelihood of Undergoing Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among US Hospitals.","authors":"Ashwin S Nathan, Kevin F Kennedy, Kriyana P Reddy, Alexander C Fanaroff, Daniel M Kolansky, Taisei J Kobayashi, Sameed Ahmed M Khatana, Elias J Dayoub, Lauren Eberly, Sunil V Rao, Roxana Mehran, Deepak Bhatt, Robert W Yeh, John A Spertus, Jay Giri","doi":"10.1161/JAHA.124.038317","DOIUrl":"https://doi.org/10.1161/JAHA.124.038317","url":null,"abstract":"<p><strong>Background: </strong>There may be variability in willingness to perform percutaneous coronary intervention (PCI) in higher-risk patients who present with ST-segment-elevation myocardial infarction (STEMI). We sought to describe current treatment selection patterns and hospital-level variability.</p><p><strong>Methods and results: </strong>We identified patients presenting with STEMI with a culprit lesion on coronary angiography between January 1, 2019, and March 31, 2023, using the NCDR (National Cardiovascular Data Registry) CPMI (Chest Pain-Myocardial Infarction) registry. We compared patient-level characteristics of patients who did and did not undergo PCI at each hospital. There were 178 984 patients from 582 US hospitals presenting with STEMI who were included. Among patients with STEMI and a culprit lesion, 6180 did not undergo PCI (3.5%). Patients with a presentation of STEMI and a culprit lesion who did not undergo PCI were older (67 [interquartile range, 58-76]) years versus 62 ([interquartile range, 54-71] years, <i>P</i><0.001), more likely to present with heart failure (15.0% versus 7.4%, <i>P</i><0.001), and more likely to have cardiac arrest before arrival (9.7% versus 5.1%, <i>P</i><0.001) than patients who underwent PCI. Patients who did not undergo PCI had higher predicted mortality rates (12.5%±17.9% versus 6.5%±11.5%, <i>P</i><0.001) and observed mortality rates (21.7% versus 6.4%, <i>P</i><0.001) compared with patients who underwent PCI.</p><p><strong>Conclusions: </strong>There is variability in the percentage of patients with culprit lesions on invasive coronary angiography undergoing PCI for STEMI, with 3.5% of patients with STEMI not receiving PCI overall, and >5% of patients not undergoing PCI in a quarter of US hospitals. Differences in observed versus predicted mortality rates for patients who did or did not undergo PCI may highlight the effects of risk-avoidant behavior.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038317"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450927","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}