JACC advances最新文献

{"title":"Lipid Management in the Post-Statin Era","authors":"Heather A. Powell PharmD, LeAnne Bloedon MS","doi":"10.1016/j.jacadv.2025.102177","DOIUrl":"10.1016/j.jacadv.2025.102177","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102177"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093165","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":"SGLT2 Inhibition After Aortic Valve Replacement","authors":"Antonin Trimaille MD, PhD , Benjamin Marchandot MD , Olivier Morel MD, PhD","doi":"10.1016/j.jacadv.2025.102136","DOIUrl":"10.1016/j.jacadv.2025.102136","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102136"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Early Nutritional Reversibility After Mitral Valve Transcatheter Edge-to-Edge Repair","authors":"Kenichi Shibata PT ,&nbsp;Masanori Yamamoto MD ,&nbsp;Ai Kagase MD ,&nbsp;Takahiro Tokuda MD ,&nbsp;Hiroshi Tsunamoto MD ,&nbsp;Atsushi Sugiura MD ,&nbsp;Tetsuro Shimura MD ,&nbsp;Azusa Kurita MD ,&nbsp;Ryo Yamaguchi MD ,&nbsp;Mike Saji MD ,&nbsp;Yuki Izumi MD ,&nbsp;Masahiko Asami MD ,&nbsp;Yusuke Enta MD ,&nbsp;Shinichi Shirai MD ,&nbsp;Masaki Izumo MD ,&nbsp;Shingo Mizuno MD ,&nbsp;Yusuke Watanabe MD ,&nbsp;Makoto Amaki MD ,&nbsp;Kazuhisa Kodama MD ,&nbsp;Hisao Otsuki MD ,&nbsp;Kentaro Hayashida MD","doi":"10.1016/j.jacadv.2025.102142","DOIUrl":"10.1016/j.jacadv.2025.102142","url":null,"abstract":"<div><h3>Background</h3><div>Mitral valve transcatheter edge-to-edge repair (M-TEER) is an established effective treatment for patients with mitral regurgitation. The Geriatric Nutritional Risk Index (GNRI) is a well-known nutritional marker that predicts mortality risk; however, no reports clarify the clinical impact of GNRI reversibility after M-TEER.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to investigate the association between GNRI reversibility and clinical outcomes after M-TEER and identify factors predicting early GNRI improvement.</div></div><div><h3>Methods</h3><div>Data from 1,909 patients enrolled in the Japanese multicenter registry whose GNRI values were measured before and 1 month after undergoing M-TEER were retrospectively reviewed. Changes in GNRI (Δ-GNRI) were calculated and divided into two groups, namely improved GNRI (Δ-GNRI &gt;0) and worsening GNRI (Δ-GNRI ≤0) groups. Multivariate logistic regression analysis was performed to explore factors associated with improvement in Δ-GNRI. Cox regression analysis was used to examine associations with long-term all-cause mortality or composite outcome.</div></div><div><h3>Results</h3><div>Among the 1,909 patients, GNRI improved in 54.8% of patients. The median follow-up period was 1.3 years; 433 patients died during the follow-up period. The Δ-GNRI improvement was significantly associated with younger age, achievement of acute procedural success, lower high-sensitivity C-reactive protein, and preprocedural high GNRI value (all <em>P</em> &lt; 0.05), and was significantly associated with a lower risk of death and composite outcome.</div></div><div><h3>Conclusions</h3><div>The Δ-GNRI is a useful predictor of long-term prognosis, with reversibility observed in half of patients after M-TEER. Improvement in Δ-GNRI is associated with acute procedural success, underscoring the importance of assessing the potential for procedural success before M-TEER.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102142"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088289","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":"Beyond Symmetry and Expansion","authors":"Ioannis Skalidis MD, PhD,&nbsp;Philippe Garot MD,&nbsp;Bernard Chevalier MD,&nbsp;Hakim Benamer MD,&nbsp;Mariama Akodad MD, PhD","doi":"10.1016/j.jacadv.2025.102182","DOIUrl":"10.1016/j.jacadv.2025.102182","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102182"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088310","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":"Mitral Annular Function in Mitral Annular Calcification and Severe Mitral Regurgitation","authors":"Joseph Kassab MD, MS ,&nbsp;Joseph Hajj MD ,&nbsp;Serge C. Harb MD ,&nbsp;Rhonda Miyasaka MD ,&nbsp;Grant Reed MD, MSc ,&nbsp;Amar Krishnaswamy MD ,&nbsp;Kari Feldt MD ,&nbsp;Christopher U. Meduri MD, MPH ,&nbsp;A. Marc Gillinov MD ,&nbsp;Shinya Unai MD ,&nbsp;James J. Yun MD, PhD ,&nbsp;Marcus Carlsson MD ,&nbsp;Samir R. Kapadia MD ,&nbsp;Rishi Puri MD, PhD","doi":"10.1016/j.jacadv.2025.102161","DOIUrl":"10.1016/j.jacadv.2025.102161","url":null,"abstract":"<div><h3>Background</h3><div>Longitudinal left ventricular (LV) shortening, or mitral atrioventricular plane displacement (AVPD), reflects mitral annular function.</div></div><div><h3>Objectives</h3><div>The authors sought to demonstrate the use of cardiac computed tomography (CCT) to measure mitral AVPD and assess its contribution to LV stroke volume (LVSV) in patients with mitral annular calcification (MAC), severe functional mitral regurgitation (FMR), and severe primary mitral regurgitation (PMR) without MAC.</div></div><div><h3>Methods</h3><div>We included 200 patients with circumferential MAC (age 79.6 ± 10 years), 50 with severe FMR (age 74 ± 8 years), 50 with severe PMR (age 83 ± 10 years), and 50 control subjects (age 41.6 ± 16 years) who underwent CCT (2016-2022). AVPD was measured in all patients. The volume of blood attributable to AVPD (V^AVPD) and its fractional contribution to LVSV (SV^AVPD%) were calculated across all cohorts. Group comparisons were performed using <em>t</em>-tests, analysis of variance, and Chi-square tests; multivariable linear regression was used to identify independent associations with AVPD and SV^AVPD%.</div></div><div><h3>Results</h3><div>Mean AVPD differed significantly between controls, PMR, and FMR patients (11.9, 6.6, 9.9 mm; <em>P</em> &lt; 0.0001), whereas SV^AVPD% was similar (45.8%, 46.5%, 45.5%; <em>P</em> = 0.94). Among MAC patients, AVPD decreased with increasing severity (<em>P</em> &lt; 0.0001). Those with grade 3 to 4 MAC had significantly lower SV^AVPD% compared to non-MAC groups (26.7% to 28.9% vs 45.5% to 46.5%; <em>P</em> &lt; 0.0001). MAC severity was independently associated with reduced AVPD and SV^AVPD% (<em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>CCT can quantify mitral annular function and its contribution to LVSV. Moderate-to-severe MAC significantly impairs annular function, reducing its share of LVSV. These findings may inform patient selection for transcatheter mitral therapies that impact annular dynamics.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102161"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088306","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":"An Evaluation of Social Determinants of Health in Atrial Fibrillation Research, From 2014 to 2024","authors":"Evan Derector BS ,&nbsp;Daniel Ricketti MD ,&nbsp;Krystal Hunter PhD, MBA ,&nbsp;Anupam A. Kumar MD, MS","doi":"10.1016/j.jacadv.2025.102148","DOIUrl":"10.1016/j.jacadv.2025.102148","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common cardiac arrhythmia. Social determinants of health (SDH) have been implicated in the development and outcomes of cardiovascular disease; however, they are typically underreported in randomized controlled trials (RCTs). It is unknown if this holds true in the study of AF.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to investigate SDH reporting and analysis in AF RCTs.</div></div><div><h3>Methods</h3><div>A systematic review of AF RCTs in the PubMed database from 10 high-impact journals over the last decade was conducted. One reviewer assessed RCTs for characteristics associated with reporting and analyzing SDH, including demographic and socioeconomic characteristics. Descriptive statistics and logistic regressions were utilized to determine predictors of SDH characteristics.</div></div><div><h3>Results</h3><div>Of 323 RCTs, 240 were included. Nearly all reported age (99.6%) and gender (98.8%), while about 50% analyzed them (56.3% and 49.2%). Less than 33% reported or analyzed race and ethnicity and fewer than 10% addressed socioeconomic characteristics. Studies with increased participants and behavioral or pharmaceutical interventions had greater odds of analyzing age and gender. North American location and higher enrollment was associated with greater odds of reporting and analyzing race. Year of publication was associated with analyzing age and race.</div></div><div><h3>Conclusions</h3><div>While nearly all studies reported age and gender, a smaller fraction reported and analyzed race, ethnicity, and socioeconomic characteristics. Addressing these gaps is critical to evaluate the role of SDH in patient outcomes, especially in populations that are typically underrepresented in research. The current lack of standardization limits the generalizability of AF RCTs and subsequently developed clinical guidelines.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102148"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082616","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":"Deep Neural Network Algorithm Using the Electrocardiogram for Detection of Obstructive Sleep Apnea","authors":"Naima Covassin PhD ,&nbsp;Kan Liu PhD ,&nbsp;Jan Bukartyk MS ,&nbsp;Paul C. Timm MBA ,&nbsp;Paul A. Friedman MD ,&nbsp;Erik K. St. Louis MD, MS ,&nbsp;Zachi I. Attia PhD ,&nbsp;Virend K. Somers MD, PhD","doi":"10.1016/j.jacadv.2025.102139","DOIUrl":"10.1016/j.jacadv.2025.102139","url":null,"abstract":"<div><h3>Background</h3><div>Although highly prevalent, obstructive sleep apnea (OSA) remains largely underdiagnosed, thus justifying the need for high-performing screening tools.</div></div><div><h3>Objectives</h3><div>The authors sought to develop a machine learning–powered algorithm to identify OSA from the 12-lead electrocardiogram (ECG), a routine clinical test.</div></div><div><h3>Methods</h3><div>A retrospective population of 11,299 patients who completed sleep evaluation and underwent 12-lead ECG at Mayo Clinic were included. OSA was defined as an apnea-hypopnea index ≥5. A deep convolutional neural network model was constructed to detect OSA from the ECG (artificial intelligence [AI]-ECG). Predictive performance of the algorithm in the total sample and separately in males and females was evaluated using the receiver-operating characteristic curve with area under the curve (AUC).</div></div><div><h3>Results</h3><div>The population consisted of 7,170 patients with OSA and 4,129 controls (53.7% males, median [Q1-Q3] of age 58 [47-68] years). The AUC of the AI-ECG model for identification of OSA in the test sample was 0.80 (95% CI: 0.77-0.83), with accuracy, sensitivity, and specificity of 73.7%, 77.0%, and 68.6%, respectively. The model showed better discriminatory performance in females (AUC: 0.82; 95% CI: 0.79-0.86) than in males (AUC: 0.73; 95% CI: 0.68-0.78; <em>P</em> &lt; 0.001). Sensitivity analyses showed that the predictive abilities of the model were robust across different time intervals and even when including ECG recordings manifesting cardiac abnormalities.</div></div><div><h3>Conclusions</h3><div>Our AI-ECG model demonstrated good diagnostic performance as an ECG-based screening tool for OSA in a clinical population, particularly among females. Incorporating this algorithm in medical practice may enable widespread low-cost screening for OSA, optimizing early diagnosis and therapy.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102139"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082582","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":"Prognostic Value of Exercise Stress Echocardiography for Patients With Breast Cancer Treated With Chest Radiotherapy","authors":"Rafael E. Toro Manotas MD ,&nbsp;Mariana Garcia Arango MD ,&nbsp;Renzo J. Mogollon MD ,&nbsp;Jamie L. Carroll APRN, CNP, MSN ,&nbsp;Jenna E. Hoppenworth APRN, CNP, MSN ,&nbsp;Kathryn J. Ruddy MD ,&nbsp;Deanne R. Smith APRN, CNP, MSN ,&nbsp;Lori A. Thicke APRN, CNS ,&nbsp;Robert W. Mutter MD ,&nbsp;Karthik V. Giridhar MD ,&nbsp;Christine L. Klassen MD ,&nbsp;Tufia C. Haddad MD ,&nbsp;Prema P. Peethambaram MD ,&nbsp;Daniela L. Stan MD ,&nbsp;Hector R. Villarraga MD","doi":"10.1016/j.jacadv.2025.102145","DOIUrl":"10.1016/j.jacadv.2025.102145","url":null,"abstract":"<div><h3>Background</h3><div>Evidence supporting exercise stress echocardiography (ESE) for breast cancer survivors treated with chest radiotherapy is scarce, and its association with clinical outcomes has not been evaluated.</div></div><div><h3>Objectives</h3><div>The objectives of the were to evaluate the prognostic value of ESE for breast cancer survivors treated with chest radiotherapy and to assess the relationship of radiotherapy with cardiovascular death and nonfatal myocardial infarction (CVD + NFMI), major adverse cardiac events (MACE), and all-cause mortality.</div></div><div><h3>Methods</h3><div>For this retrospective study, we included 507 breast cancer survivors treated with chest radiotherapy who underwent ESE from 2000 through 2020.</div></div><div><h3>Results</h3><div>The median (IQR) follow-up was 7.8 (4.9-10.8) years; the mean (SD) age at ESE was 65.9 (9.9) years and the median time from radiotherapy to ESE was 4.3 (2.0-7.4) years. Patients completed 7.33 (2.03) metabolic equivalents. Seventy-six patients had ischemia on ESE. They were older than those with normal ESE (67.3 vs 65.6 years) and had more atrial fibrillation (14.5% vs 6.3%) and chronic obstructive pulmonary disease (5.3% vs 0.7%). There were 35 CVD + NFMI, 61 MACE, and 80 deaths. Ischemic ESE was associated with an increased risk of CVD + NFMI (HR: 2.25; 95% CI: 1.05-4.76) and MACE (HR: 3.62; 95% CI: 2.07-6.32) even after adjusting for cardiovascular risk factors, metabolic equivalents achieved, and cardiotoxic chemotherapy; the risk of all-cause mortality in these patients was not increased (HR: 1.33; 95% CI: 0.78-2.26).</div></div><div><h3>Conclusions</h3><div>An ischemic ESE predicts CVD + NFMI and MACE in patients with breast cancer treated with chest radiotherapy, independent of cardiovascular comorbid conditions and aerobic capacity. These patients should have closer follow-up and intense strategies to reduce cardiovascular risk.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102145"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082658","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":"Nonoptimal Temperature Is Associated With Higher Atrial Fibrillation Hospitalizations in China","authors":"Shihao Wang MD, PhD ,&nbsp;Xiaolei Yang MD, PhD ,&nbsp;Shaobo Shi MD, PhD ,&nbsp;Yanhong Tang MD, PhD ,&nbsp;Yushan Wei MD, PhD ,&nbsp;Yuanjun Sun MD, PhD ,&nbsp;Tesfaldet Habtemariam Hidru MD, PhD ,&nbsp;Xiaomeng Yin MD, PhD ,&nbsp;Gang Wu MD, PhD ,&nbsp;Qingyan Zhao MD, PhD ,&nbsp;Yingxue Dong MD, PhD ,&nbsp;Lianjun Gao MD, PhD ,&nbsp;Gary Tse MD, PhD ,&nbsp;Congxin Huang MD, PhD ,&nbsp;He Huang MD, PhD ,&nbsp;Yunlong Xia MD, PhD","doi":"10.1016/j.jacadv.2025.102143","DOIUrl":"10.1016/j.jacadv.2025.102143","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have evaluated extreme temperatures' impact on cardiovascular health, but few have specifically focused on atrial fibrillation (AF)-related hospitalizations across a wide temperature range.</div></div><div><h3>Objectives</h3><div>This study aimed to quantify and investigate the association between ambient nonoptimal temperatures and AF hospitalizations.</div></div><div><h3>Methods</h3><div>A two-stage time-stratified case-crossover study was conducted using a nationwide registry of 1,665,014 AF patients from 251 cities between 2014 and 2023. Conditional quasi-Poisson and distributed lag nonlinear models analyzed associations between nonoptimal temperature and AF hospitalizations. Subgroup and attributable burden analyses identified potentially susceptible subpopulations.</div></div><div><h3>Results</h3><div>The minimum hospitalization temperature for AF was 24.3 °C (74th percentile). Compared to the minimum hospitalization temperature over a lag of 0 to 14 days, cumulative relative risks for extreme cold and heat (1st and 99th percentiles) were 1.32 (95% CI: 1.24-1.42) and 1.03 (95% CI: 0.99-1.07), respectively. Hospitalization risks related to extreme temperatures were similar across subgroups of age, sex, and baseline diseases. Overall, 14.3% (95% empirical CI [eCI]: 12.2%-14.8%) of AF hospital admissions were attributable to nonoptimal temperatures, with higher burden in northern China (18.4%; 95% eCI: 15.7%-19.4%) than southern China (12.4%; 95% eCI: 9.6%-13.6%).</div></div><div><h3>Conclusions</h3><div>In this nationwide sample, extreme cold temperatures were associated with a greater risk of AF hospitalization. Excess risk was observed in northern China, where low temperatures prevail. This evidence highlights the importance of effective health care management and early resource allocation in high-risk regions.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102143"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082661","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":"Mortality After Non–ST-Segment Elevation Myocardial Infarction","authors":"Nina Stødkilde-Jørgensen MD ,&nbsp;Kevin KW. Olesen MD, PhD ,&nbsp;Christine Gyldenkerne MD, PhD ,&nbsp;Malene K. Hansen MD ,&nbsp;Bjarne L. Nørgaard MD, PhD ,&nbsp;Troels Thim MD, PhD ,&nbsp;Roni R. Nielsen MD, PhD ,&nbsp;Michael Maeng MD, PhD","doi":"10.1016/j.jacadv.2025.102155","DOIUrl":"10.1016/j.jacadv.2025.102155","url":null,"abstract":"<div><h3>Background</h3><div>Non–ST-segment elevation myocardial infarction (NSTEMI) due to coronary artery disease (CAD) can lead to reduced left ventricular ejection fraction (LVEF) and increased mortality. However, the interplay between LVEF and obstructive CAD on mortality has not been examined in patients with NSTEMI.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine the combined prognostic impact of LVEF and CAD on mortality following an NSTEMI.</div></div><div><h3>Methods</h3><div>We included patients referred to coronary angiography due to first-time NSTEMI with obstructive CAD registered in the Western Denmark Heart Registry. Patients were grouped according to LVEF (&gt;50%, 41% to 50%, and ≤40%) and the extent of obstructive CAD defined by vessel disease (VD) (1VD, 2VD, and 3VD). Five-year cumulative incidence proportions and HRs of mortality were calculated. Excess mortality was assessed by comparison with a sex- and age-matched general population cohort.</div></div><div><h3>Results</h3><div>In total, 8,770 patients with NSTEMI and obstructive CAD were included between 2010 and 2021. The lowest 5-year mortality was observed for patients with LVEF &gt;50% and 1VD (9%), followed by an increase with decreasing LVEF and increasing CAD. The highest mortality was observed for patients with LVEF ≤40% and 3VD (46%; adjusted HR 3.05; 95% CI: 2.51-3.70). This relationship was confirmed by comparison with the matched general population, where patients with LVEF ≤40% and 3VD had 24% higher absolute mortality.</div></div><div><h3>Conclusions</h3><div>In patients with NSTEMI, the combined information on LVEF and the extent of obstructive CAD was associated with an increasing 5-year mortality. A comparison with a matched general population confirmed the findings.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102155"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082563","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}