JACC advances最新文献

{"title":"Clinical Profiles and Outcomes of Adult Congenital Heart Disease Patients in the Cardiac Intensive Care Unit","authors":"Luke J. Burchill MBBS, PhD ,&nbsp;Viral K. Desai MBBS ,&nbsp;Maan Jokhadar MD ,&nbsp;Cameron Dezfulian MD ,&nbsp;Heidi M. Connolly MD ,&nbsp;Alexander C. Egbe MBBS, MPH ,&nbsp;William R. Miranda MD ,&nbsp;C. Charles Jain MD ,&nbsp;Jacob C. Jentzer MD","doi":"10.1016/j.jacadv.2025.101710","DOIUrl":"10.1016/j.jacadv.2025.101710","url":null,"abstract":"<div><h3>Background</h3><div>There is limited evidence to guide care and improve outcomes among critically ill adult congenital heart disease (ACHD) patients.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine the clinical profile and outcomes of ACHD patients admitted to an academic cardiac intensive care unit (CICU).</div></div><div><h3>Methods</h3><div>Retrospective cohort study of Mayo Clinic CICU admissions (2007-2018), including those who had been evaluated in our ACHD clinic. Critical care diagnoses (CCD) at the time of admission and critical care therapies (CCT) during the CICU stay were examined. Logistic regression and Cox proportional hazards regression were used to evaluate in-hospital and 1-year mortality, respectively.</div></div><div><h3>Results</h3><div>Among 12,428 unique CICU admissions, 253 (2.0%) had ACHD (52.6% female, median age 41.5 [IQR: 31.5-53.5] years), classified as severe in 103 (40.9%); 49.0% had a CCD or CCT. Compared to non-ACHD, ACHD patients were more likely to have heart failure, atrial and ventricular arrhythmias. In-hospital mortality occurred in 22 (8.7%) ACHD patients and was higher among patients with CCD or requiring CCT, especially severe ACHD. One-year survival was lower for those with CCD (64.1% vs 87.5%, <em>P</em> &lt; 0.001) or CCT (68.5% vs 84.5%; <em>P</em> = 0.001). Following multivariable adjustment, ACHD patients had higher in-hospital mortality (adjusted OR: 1.76; 95% CI: 1.01-2.94; <em>P</em> = 0.04) and higher risk of 1-year mortality (adjusted HR: 1.42; 95% CI: 1.06-1.89; <em>P</em> = 0.02). A total of 101 (43.9%) hospital survivors were readmitted within 1 year.</div></div><div><h3>Conclusions</h3><div>ACHD patients in the CICU experience high readmission rates and mortality. Tailored treatment strategies are needed to improve outcomes for critical ACHD patients.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101710"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060579","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":"Critical Care Cardiology","authors":"Barinder S. Hansra MD ,&nbsp;Andrea M. Elliott MD ,&nbsp;Ann Gage MD ,&nbsp;Christopher F. Barnett MD ,&nbsp;Brandon Wiley MD","doi":"10.1016/j.jacadv.2025.101816","DOIUrl":"10.1016/j.jacadv.2025.101816","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 101816"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176092","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":"Personalizing Temperature Targets After Cardiac Arrest","authors":"Justin D. Mark MD ,&nbsp;Jose L. Lopez MD ,&nbsp;Waseem Wahood MD, MS ,&nbsp;Rosario A. Colombo MD ,&nbsp;Mauricio Danckers MD ,&nbsp;Abdulla A. Damluji MD, PhD, MBA ,&nbsp;Jason N. Katz MD, MHS ,&nbsp;Carlos L. Alviar MD","doi":"10.1016/j.jacadv.2025.102042","DOIUrl":"10.1016/j.jacadv.2025.102042","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102042"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796292","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":"Serum Transthyretin as Prognostic Biomarker for Cardiovascular Events and Mortality","authors":"Dimitrios Terentes-Printzios MD, PhD ,&nbsp;Maria Eleni Koilakou MD ,&nbsp;Polyxeni Alexiou MD,&nbsp;Alexios Antonopoulos MD, PhD,&nbsp;Alexandros Kasiakogias MD, PhD,&nbsp;Themistoklis Katsimichas MD, PhD,&nbsp;Georgios Lazaros MD, PhD,&nbsp;Theodoros Tsampras MD,&nbsp;Freideriki Eleni Kourti MD,&nbsp;Nikolaos Ioakeimidis MD, PhD,&nbsp;Konstantinos Tsioufis MD, PhD,&nbsp;Charalambos Vlachopoulos MD, PhD","doi":"10.1016/j.jacadv.2025.102208","DOIUrl":"10.1016/j.jacadv.2025.102208","url":null,"abstract":"<div><h3>Background</h3><div>Serum transthyretin (TTR) levels, a key player in the occurrence of amyloidosis, have also emerged as a potential biomarker in cardiovascular (CV) disease and all-cause mortality. However, it is unclear whether TTR levels predict future events.</div></div><div><h3>Objectives</h3><div>This meta-analysis sought to evaluate the prognostic utility in longitudinal studies of serum TTR levels in predicting CV events, heart failure (HF), CV mortality, and all-cause mortality across diverse patient populations.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across major electronic databases and gray literature up to May 2025. Studies reporting HRs or risk estimates for the association between serum TTR levels and outcomes of interest (CV events and mortality) were included. Two reviewers extracted data independently and summary estimates of association were obtained using a random-effects model. The primary outcomes were risk ratios for total CV events, HF, all-cause mortality, and CV mortality.</div></div><div><h3>Results</h3><div>A total of 34 studies involving 83,929 participants, 50.5% females, mean age 61.45 years old, and a mean follow-up of 41 months were included in the analysis. Low serum TTR levels were found to be significantly associated with an increased risk of CV events (HR: 1.54; 95% CI: 1.30-1.83; <em>P</em> &lt; 0.001), all-cause mortality (HR: 1.65; 95% CI: 1.50-1.82; <em>P</em> &lt; 0.001), CV mortality (HR: 2.08; 95% CI: 1.26-3.44; <em>P</em> = 0.004), and heart failure (HR: 1.72; 95% CI: 1.35-2.21; <em>P</em> &lt; 0.001). A decrease in TTR by 10 mg/dL corresponded with an increase in risk of 30%, 73%, 46%, and 28% in total CV, all-cause mortality, CV mortality, and HF, respectively. In meta-regression analysis, low TTR levels in younger male subjects, preserved ejection fraction and elevated N-terminal pro-B-type natriuretic peptide levels were associated with a higher risk of all-cause mortality.</div></div><div><h3>Conclusions</h3><div>Serum TTR is a predictor of CV events, all-cause and CV mortality, and HF across different populations, underscoring its potential use as a CV biomarker and instigating research on the possible clinical role of TTR medications in other clinical settings other than amyloidosis.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102208"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214571","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":"Distal Radial Access vs Transradial Access in Patients With ST-Segment Elevation Myocardial Infarction","authors":"Jun-Won Lee MD, PhD ,&nbsp;Chan Joon Kim MD, PhD ,&nbsp;Bong-Ki Lee MD, PhD ,&nbsp;Sung Gyun Ahn MD, PhD ,&nbsp;Young Jin Youn MD, PhD ,&nbsp;Jung-Hee Lee MD, PhD ,&nbsp;Ho Sung Jeon MD ,&nbsp;Su Yong Kim MD ,&nbsp;Jaehyuk Jang MD ,&nbsp;Seonghyeon Bu MD ,&nbsp;Hyo-Suk Ahn MD, PhD ,&nbsp;Sungmin Lim MD, PhD ,&nbsp;Hyeon Woo Yim MD, PhD ,&nbsp;Seung-Hwan Lee MD, PhD","doi":"10.1016/j.jacadv.2025.102200","DOIUrl":"10.1016/j.jacadv.2025.102200","url":null,"abstract":"<div><h3>Background</h3><div>Distal radial access (DRA) has emerged as an alternative to transradial access (TRA) in coronary procedures. However, evidence supporting its use in ST-segment elevation myocardial infarction (STEMI) remains limited.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to assess whether DRA is noninferior to TRA in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI.</div></div><div><h3>Methods</h3><div>This multicenter, open-label, randomized controlled trial was conducted at 3 centers in South Korea. Patients undergoing primary PCI for STEMI were randomly assigned to either the DRA or TRA group. The primary endpoint was the puncture success rate. A noninferiority testing with a prespecified margin of 5.65% was performed in the intention-to-treat, per-protocol, and as-treated populations (<span><span>NCT03611725</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>From August 2018 to February 2023, 354 patients were randomized to DRA (n = 176) or TRA (n = 178). The primary endpoint, puncture success rate was 94.3% in DRA and 96.1% in TRA (difference −1.75%; 95% CI −6.20% to 2.71%) in the intention-to-treat analysis. The per-protocol analysis also failed to demonstrate noninferiority (difference −1.72%; 95% CI -5.99% to 2.54%). DRA demonstrated noninferiority to TRA in the as-treated population (difference −1.17%; 95% CI -5.56% to 3.22%). The rates of successful coronary angiography and PCI, access-site crossover, and bleeding complications were comparable between groups. One radial artery occlusion occurred in TRA group at 1-month follow-up.</div></div><div><h3>Conclusions</h3><div>In STEMI patients, DRA failed to demonstrate noninferiority to TRA in terms of puncture success. However, both access routes showed comparable procedural efficacy and safety. Further validation with a larger, adequately powered study is required to confirm these findings.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102200"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201554","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":"A Novel N-Terminal Pro-B-Type Natriuretic Peptide Assay in the Early Diagnosis of Acute Heart Failure","authors":"Maria Belkin MD ,&nbsp;Desiree Wussler MD ,&nbsp;Pedro Lopez-Ayala MD ,&nbsp;Albina Nowak MD ,&nbsp;Danielle M. Gualandro MD ,&nbsp;Dilbar Sailova MD ,&nbsp;Codruta Popescu MD ,&nbsp;Ivo Strebel PhD ,&nbsp;Marie Niggemann Ms ,&nbsp;Julia Reinhardt PhD ,&nbsp;Gabrielle Huré MS ,&nbsp;Nikola Kozhuharov MD ,&nbsp;Freya Jenkins MD ,&nbsp;Emel Kaplan PhD ,&nbsp;Fabiana Sgueglia Ms ,&nbsp;Zaid Sabti MD ,&nbsp;Laureve Chollet MD ,&nbsp;Katharina Rentsch PhD ,&nbsp;Joanna Gawinecka MD ,&nbsp;Felix Mahfoud MD ,&nbsp;Christian Mueller MD","doi":"10.1016/j.jacadv.2025.102206","DOIUrl":"10.1016/j.jacadv.2025.102206","url":null,"abstract":"<div><h3>Background</h3><div>The performance of the novel NT-pro-B-type natriuretic peptide (NT-proBNP)-Access assay in the early diagnosis of acute heart failure (AHF) is unknown.</div></div><div><h3>Objectives</h3><div>The objective of the study was to assess the diagnostic accuracy of NT-proBNP-Access in patients presenting with acute dyspnea and compare it to the established NT-proBNP-Elecsys assay.</div></div><div><h3>Methods</h3><div>In a prospective multicenter diagnostic study enrolling patients presenting with acute dyspnea to the emergency department, NT-proBNP-Access was measured in a blinded fashion and compared to NT-proBNP-Elecsys concentrations. The primary endpoint was diagnostic accuracy quantified by area under the receiver operating characteristics curve (AUC). Secondary endpoints were the performance of the guideline-recommended clinical decision values (rule-out: &lt;300 pg/mL, rule-in: age-adjusted &gt;450/900/1,800 pg/mL) for AHF.</div></div><div><h3>Results</h3><div>Among 1,400 patients (53% AHF), the NT-proBNP-Access assay yielded significantly higher NT-proBNP concentrations vs the NT-proBNP-Elecsys assay (median 2,087 pg/mL vs 1,568 pg/mL [<em>P</em> &lt; 0.001]). The NT-proBNP-Access assay had very high diagnostic accuracy (AUC: 0.914; 95% CI: 0.898-0.93), which was slightly lower than the NT-proBNP-Elecsys assay (AUC: 0.922; 95% CI: 0.908-0.937; <em>P</em> = 0.006). Using guideline-recommended clinical decision values, the NT-proBNP-Access assay ruled out fewer patients compared to NT-proBNP-Elecsys (18.7% vs 26.3%) with similar sensitivity (98.9% vs 98.5%). Conversely, more patients were ruled in (58.1% vs 52.1%), with lower specificity (77.6% vs 84.8%; <em>P</em> &lt; 0.001). Diagnostic concordance was high (85.3%), with major mismatch (no AHF vs AHF) uncommon (0.6%), but minor mismatch (gray zone vs rule in/rule out and vice versa) common (14.1%).</div></div><div><h3>Conclusions</h3><div>The NT-proBNP-Access assay had a very high diagnostic accuracy for AHF. Levels were approximately 25% higher with NT-proBNP-Access vs NT-proBNP-Elecsys, resulting in minor diagnostic discordance in 1 of 7 patients using guideline-recommended decision values.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102206"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202261","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":"Association of Uric Acid-Lowering Therapies on Gout Frequency with Bempedoic Acid","authors":"Kausik K. Ray MD ,&nbsp;Stephen J. Nicholls PhD ,&nbsp;A. Michael Lincoff MD ,&nbsp;Na Li PhD ,&nbsp;Heather A. Powell PharmD ,&nbsp;Peter M. Herout PharmD ,&nbsp;LeAnne Bloedon MS ,&nbsp;Steven E. Nissen MD","doi":"10.1016/j.jacadv.2025.102207","DOIUrl":"10.1016/j.jacadv.2025.102207","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102207"},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159691","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":"Multicenter Prospective Assessment of Coronary Microvascular Dysfunction","authors":"Brian A. Bergmark MD ,&nbsp;Samit Shah MD, PhD ,&nbsp;Olga Toleva MD ,&nbsp;Aziz Maksoud MD ,&nbsp;Kathleen E. Kearney MD ,&nbsp;Yuhei Kobayashi MD ,&nbsp;Akl C. Fahed MD, MPH ,&nbsp;Hayder Hashim MD ,&nbsp;Alok Sharma MD ,&nbsp;John Blair MD ,&nbsp;Bassem M. Chehab MD ,&nbsp;Uday Kanakadandi MD ,&nbsp;Farouc A. Jaffer MD, PhD ,&nbsp;Allen Jeremias MD ,&nbsp;David A. Gross MD, PhD ,&nbsp;Raj Baljepally MD ,&nbsp;Ziad A. Ali MD ,&nbsp;Gautam Reddy MD ,&nbsp;Evan Shlofmitz DO ,&nbsp;Issam Moussa MD ,&nbsp;Marc S. Sabatine MD, MPH","doi":"10.1016/j.jacadv.2025.102179","DOIUrl":"10.1016/j.jacadv.2025.102179","url":null,"abstract":"<div><h3>Background</h3><div>Coronary microvascular dysfunction (CMD) and vasospastic angina (VSA) are common, yet underdiagnosed. Existing studies of invasive CMD/VSA assessment have specified patient selection and procedural technique, with little known about testing use in real-world practice.</div></div><div><h3>Objectives</h3><div>The purpose of the study was to observe procedural and therapeutic decision-making for patients undergoing invasive CMD/VSA assessment.</div></div><div><h3>Methods</h3><div>FlowLab was a multicenter, prospective study of patients with possible CMD in whom the treating physician used the CoroFlow bolus thermodilution system to measure coronary flow reserve and index of microcirculatory resistance (IMR). As the purpose was to observe how testing is performed in current practice, procedural technique, including whether to perform vasospasm testing, was at operator discretion. Procedural data were collected in real-time.</div></div><div><h3>Results</h3><div>Two hundred fifty-three procedures were performed at 14 U.S. sites. The most common presenting symptoms were chest pain (222/253; 88%) and dyspnea (93/253; 37%). The median CoroFlow duration was 10 (IQR: 7-14) minutes and provocative vasospasm testing was performed in 50% (124/246). Forty-three percent (110/253) of patients had abnormal coronary flow reserve (&lt;2.5) and 28% (72/253) had abnormal IMR (≥25). CMD/VSA was identified in 53% (135/253) of patients, with a final diagnosis of CMD in 59% (19/32) of these and VSA in 28% (9/32). Anginal therapy addition was more common in those with elevated IMR (61% [44/72] vs 29% [53/181]; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>In a prospective assessment of invasive testing for CMD/VSA, we observed varied procedural and technical approaches. Testing was rapid, and a final diagnosis of CMD or VSA was common with immediate implications for patient management. Further integration of CMD/VSA evaluation may help address current gaps in diagnosis and treatment.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102179"},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159690","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":"Cardioprotective Role of Coronary Collaterals in the Development of Intramyocardial Hemorrhage in ST-Segment Elevation MI Patients","authors":"Keyur P. Vora MD, MS ,&nbsp;Ankur Kalra MD, MSc ,&nbsp;Khalid Youssef PhD ,&nbsp;Kinjal Bhatt MD ,&nbsp;Tejas Pandya MD ,&nbsp;Andreas Kumar MD ,&nbsp;Rohan Dharmakumar PhD ,&nbsp;MIRON-CL Investigators","doi":"10.1016/j.jacadv.2025.102169","DOIUrl":"10.1016/j.jacadv.2025.102169","url":null,"abstract":"<div><h3>Background</h3><div>Intramyocardial hemorrhage (IMH), evident in 40% of revascularized ST-segment elevation myocardial infarction (STEMI) patients, is a lethal determinant of MI size. IMH compromises myocardial salvage and drives major adverse cardiovascular events.</div></div><div><h3>Objectives</h3><div>We sought to determine whether the presence and extent of coronary collaterals affect development of IMH in STEMI patients.</div></div><div><h3>Methods</h3><div>The MIRON-CL trial (<span><span>NCT05898425</span><svg><path></path></svg></span>) enrolled 294 consecutive STEMI patients reperfused via primary percutaneous coronary intervention (PCI). All underwent pre-PCI angiography to determine Rentrop collateral grades (0: none; III: complete). Three days post-PCI cardiac magnetic resonance imaging quantified myocardial area at risk (T2 edema), IMH (T2∗), and MI (late gadolinium enhancement).</div></div><div><h3>Results</h3><div>Among 294 patients, 124 had IMH and 170 did not. Patients with no collaterals (CL−, Grade 0) had higher IMH (7.41% ± 5.33% left ventricle) than those with collaterals (CL+; Grade I: 5.23% ± 3.21%, II: 3.11% ± 2.78%, III: 2.05% ± 1.89%; <em>P</em> &lt; 0.001). Total area at risk post-PCI was larger in CL− (37.62% ± 15.32% left ventricle) than in CL+ (21.48% ± 13.21%; <em>P</em> &lt; 0.001). Absence of collaterals correlated with larger MI (CL− 38.66% ± 14.63% vs CL+ 19.84% ± 13.72%; <em>P</em> &lt; 0.001) and higher microvascular obstruction (CL− 8.07% ± 6.60% vs CL+ 2.17% ± 2.35%; <em>P</em> &lt; 0.001). Patients without collaterals had a higher adjusted risk of IMH (OR: 5.71; 95% CI: 3.16–10.33; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Extent of coronary collaterals is a determinant of IMH in revascularized STEMI. Since IMH is known to drive post-PCI infarct expansion, determination of collateral status has the potential to identify patients at high risk of infarct expansion. For these high-risk patients, novel targeted therapies to reduce IMH, limit post-MI infarct expansion, and improve outcomes should be further explored.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102169"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159689","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":"A Fixed-Dose Solution for a Complex Problem: Can Polypills and Implementation Science Improve GDMT Uptake in HFrEF?","authors":"Quan M Bui, Max Jason","doi":"10.1016/j.jacadv.2025.102196","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102196","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102196"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253932","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}