American Journal of Cardiovascular Drugs最新文献

{"title":"Sodium-Glucose Cotransporter-2 Inhibitors: Elevating Standards in Cardiovascular Secondary Prevention","authors":"Antonio Greco","doi":"10.1007/s40256-024-00666-0","DOIUrl":"10.1007/s40256-024-00666-0","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"625 - 628"},"PeriodicalIF":2.8,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Drugs that Should be Avoided or Used with Caution in Patients Hospitalized for Acute Decompensated Heart Failure","authors":"Marwan Sheikh-Taha","doi":"10.1007/s40256-024-00663-3","DOIUrl":"10.1007/s40256-024-00663-3","url":null,"abstract":"<div><h3>Background</h3><p>Heart failure (HF) is a pervasive global health concern, with acute decompensated heart failure (ADHF) contributing significantly to morbidity and mortality. Medications used in patients with HF may exacerbate HF or prolong the QT interval, posing additional risks.</p><h3>Objective</h3><p>The objective is to assess the prevalence and utilization patterns of medications known to cause or exacerbate HF and prolong the QT interval among patients with ADHF. Understanding these patterns is crucial for optimizing patient care and minimizing potential risks.</p><h3>Methods</h3><p>A retrospective chart review was conducted at Huntsville Hospital, Huntsville, USA, covering 602 patients with ADHF over a 40-month period. Inclusion criteria involved age ≥ 18 years, a history of HF, and ADHF admission. The 2016 American Heart Association Scientific Statement was used to identify drugs that may cause or exacerbate HF and those that could prolong the QT interval</p><h3>Results</h3><p>Among the 602 patients, 57.3% received medications causing or exacerbating HF, notably albuterol (34.9%) and diabetes medications (20.4%), primarily metformin, followed by urologic agents (14.3%), mostly tamsulosin, and nonsteroidal anti-inflammatory drugs (NSAIDs) (6.1%). Moreover, 82.9% were on medications prolonging the QT interval, with loop diuretics, amiodarone, ondansetron, and famotidine most prevalent. Furthermore, 42.1% of the patients received more than two concomitant medications that prolong the QT interval, which can further exacerbate the risk of torsades de pointes.</p><h3>Conclusion</h3><p>This study underscores the high prevalence of HF-causing or HF-exacerbating medications and QT-prolonging drugs in patients with ADHF. Healthcare professionals must be cognizant of these patterns, advocating for safer prescribing practices to optimize patient outcomes and reduce the burden of HF-related hospitalizations.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"685 - 691"},"PeriodicalIF":2.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empagliflozin Effects in Patients with ST-Elevation Myocardial Infarction Undergoing Primary PCI: The EMI-STEMI Randomized Clinical Trial","authors":"Elnaz Khani,&nbsp;Naser Aslanabadi,&nbsp;Kazem Mehravani,&nbsp;Haleh Rezaei,&nbsp;Hoda Afsharirad,&nbsp;Taher Entezari-Maleki","doi":"10.1007/s40256-024-00662-4","DOIUrl":"10.1007/s40256-024-00662-4","url":null,"abstract":"<div><h3>Introduction</h3><p>Empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, improves cardiovascular outcomes in heart failure patients, but data regarding the efficacy of empagliflozin in the setting of acute myocardial infarction (AMI) is still unclear. The current study aimed to evaluate whether treatment with empagliflozin before primary percutaneous coronary intervention (PCI) improves parameters associated with patients’ outcomes.</p><h3>Methods</h3><p>We randomly assigned 101 non-diabetic and non-heart failure patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI to receive either empagliflozin (10 mg before PCI and once daily for 40 days) or placebo, in addition to the standard treatment. The primary outcomes were changes in left ventricular ejection fraction (LVEF) 40 days after PCI, changes in cardiac troponin I (cTnI) and estimates of its area under the curve (AUC) and the peak level, and resolution of ST-segment in &gt; 50% of leads 90 min after PCI.</p><h3>Results</h3><p>No significant difference was observed in terms of the occurrence of ST-segment resolution &gt; 50% (46.0% versus 45.0%; <i>p</i> = 0.92) and the mean level of cTnI at each time point between the two groups. The estimated mean [standard deviation (SD)] AUC of cTnI was 955.0 (595.7) ng h/ml in the intervention and 999.7 (474.7) ng h/ml in the control groups (<i>p</i> = 0.85) without any significant difference in peak cTnI level. The mean (SD) LVEF 40 days after primary PCI was significantly higher in empagliflozin-treated patients than the placebo group [43.2% (5.8%) versus 39.2% (6.7%); <i>p</i> = 0.002].</p><h3>Conclusion</h3><p>In this study, no significant differences were observed across the groups in terms of cTnI levels and ST-segment resolution in patients with STEMI undergoing primary PCI. However, it shed light on the potential benefits of empagliflozin in improving LVEF following STEMI.</p><h3>Registration</h3><p>Iranian Registry of Clinical Trials Platform (https://irct.behdasht.gov.ir/) identifier number IRCT20111206008307N42.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"673 - 684"},"PeriodicalIF":2.8,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of SGLT2 Inhibitors on Atrial Fibrillation Recurrence after Catheter Ablation in Type 2 Diabetes Mellitus: A Meta-Analysis of Reconstructed Kaplan–Meier Curves with Trial Sequential Analysis","authors":"Youssef Soliman,&nbsp;Mohamed Abuelazm,&nbsp;Basma Ehab Amer,&nbsp;Mishaal Hukamdad,&nbsp;Mohamed Hatem Ellabban,&nbsp;Nada Ibrahim Hendi,&nbsp;Adel Mouffokes,&nbsp;Basel AbdelAzeem,&nbsp;Hatem Hassaballa","doi":"10.1007/s40256-024-00661-5","DOIUrl":"10.1007/s40256-024-00661-5","url":null,"abstract":"<div><h3>Purpose</h3><p>The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in managing cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is evolving. This meta-analysis seeks to explore the influence of SGLT2i on the recurrence of atrial fibrillation (AF) following catheter ablation (CA) in individuals with T2DM qualitatively and quantitatively.</p><h3>Methods</h3><p>A comprehensive literature search was conducted in electronic databases. Studies meeting predefined criteria were included. Individual patient data (IPD) were used from reconstructed time-to-event data to estimate hazard ratios (HRs) and 95% confidence intervals for AF recurrence. IPD meta-analysis was followed by a direct meta-analysis to assess the risk of AF recurrence.</p><h3>Results</h3><p>A total of five studies [one randomized controlled trial (RCT) and four cohort studies] were included in this study, and five studies were included in the qualitative analysis, while four studies comprising 1043 patients with T2DM were included in the quantitative analysis. The pooled Kaplan–Meier curve based on reconstructed data showed a significantly lower risk of AF recurrence in the SGLT2i group compared with all antidiabetic drugs (log-rank <i>P</i> = 0.00011) and dipeptidyl-peptidase IV inhibitors (DPP4i) (log-rank <i>P</i> = 0.01). Cox regression analysis showed consistent results. Direct meta-analysis showed that SGLT2i, compared with all antidiabetic medications (HR 0.57, 95% CI [0.44, 0.73], <i>I</i>²) and DPP4i (HR 0.41, 95% CI [0.24, 0.70], <i>I</i>²), was associated with a lower risk of AF recurrence.</p><h3>Conclusions</h3><p>SGLT2i are associated with a reduced risk of AF recurrence after CA in patients with T2DM. These results suggest that SGLT2i is promising in improving clinical outcomes for this population.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"629 - 640"},"PeriodicalIF":2.8,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Activated Charcoal on Mavacamten Pharmacokinetics in Healthy Participants","authors":"Samira Merali,&nbsp;Manting Chiang,&nbsp;Caroline Sychterz,&nbsp;Longfei Chao,&nbsp;Tara Simmons,&nbsp;Yiru Xu,&nbsp;Alice Zhao,&nbsp;Massimo Attanasio,&nbsp;Bindu Murthy,&nbsp;Vidya Perera","doi":"10.1007/s40256-024-00659-z","DOIUrl":"10.1007/s40256-024-00659-z","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the effect of activated charcoal on the single-dose pharmacokinetics of mavacamten when administered 2 h or 6 h after mavacamten dosing.</p><h3>Methods</h3><p>In this open-label, randomized, parallel-group study, healthy adults were randomized into three groups to receive mavacamten 15 mg alone or mavacamten 15 mg plus activated charcoal 50 g administered either 2 h or 6 h after mavacamten dosing. Pharmacokinetic parameters were derived from plasma concentration–time data using noncompartmental methods.</p><h3>Results</h3><p>Of the 45 participants randomized, 37 completed the study. When activated charcoal was administered 2 h after mavacamten dosing, mavacamten absorption and exposure were reduced compared with when mavacamten was administered alone: the area under the concentration–time curve from 0 to 72 h (AUC_0–72) and area under the concentration–time curve from time 0 extrapolated to infinity (AUC_INF) were reduced by 14% and 34%, respectively. The maximum plasma concentration (<i>C</i>_max) was also slightly lower when activated charcoal was administered 2 h after mavacamten dosing than with mavacamten alone. Pharmacokinetic profiles were similar for mavacamten alone and mavacamten plus activated charcoal administered 6 h after mavacamten dosing.</p><h3>Conclusions</h3><p>Activated charcoal was successful in reducing mavacamten absorption and exposure when administered as soon as possible after identification of a need for adsorption (2 h after mavacamten dosing). No change in exposure was observed when activated charcoal was administered 6 h after mavacamten dosing.</p><h3>Clinical Trial Registration</h3><p>NCT05320094</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"569 - 575"},"PeriodicalIF":2.8,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Tafolecimab in Chinese Patients with Hypercholesterolemia: A Systematic Review and Meta-analysis","authors":"Eeshal Fatima,&nbsp;Zaheer Qureshi,&nbsp;Mikail Khanzada,&nbsp;Adnan Safi,&nbsp;Obaid Ur Rehman,&nbsp;Faryal Altaf","doi":"10.1007/s40256-024-00654-4","DOIUrl":"10.1007/s40256-024-00654-4","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Cardiovascular disease was the leading cause of death worldwide in 2021, with atherosclerotic cardiovascular disease, encompassing hypercholesterolemia, being a major contributing factor. A range of lipid-lowering medications is used for the management of hyperlipidemia, but the use of statins is considered as standard therapy. Unfortunately, some patients do not respond to this therapy, necessitating novel therapeutic approaches. Tafolecimab is a novel proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody that inhibits the binding of PCSK9 with low-density lipoprotein receptors (LDLRs) and increases LDLR recycling, and thus it indirectly lowers circulating low-density lipoprotein cholesterol (LDL-C) levels by increasing LDL-C uptake. The primary objective of this study is to assess the efficacy of tafolecimab in reducing LDL-C levels.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A thorough search was conducted on Medline (PubMed), Cochrane CENTRAL, Scopus, and Google Scholar from inception until December 2023. Review Manager was used for statistical analysis. The random effects model was used to calculate risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs). Heterogeneity was assessed using the Higgins &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; index. The risk of bias was assessed using Cochrane’s RoB 2 tool. This review has been registered with PROSPERO (CRD42023471020).&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of four Chinese studies matched the inclusion criteria and were included in this review. A total of 726 patients were included in this review, out of which 476 patients were males. Out of four, three studies that studied the efficacy of 450 mg tafolecimab every 4 weeks in patients (&lt;i&gt;n&lt;/i&gt; = 462) as compared to placebo (&lt;i&gt;n&lt;/i&gt; = 224) were included in the meta-analysis. According to the pooled results, tafolecimab caused a significant decrease in LDL-C levels from baseline to week 12 as compared to placebo (MD = − 63.78, 95% CI − 65.88 to − 61.68, &lt;i&gt;p&lt;/i&gt; value &lt; 0.00001, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 97%). The pooled results showed that more patients achieved ≥ 50% reductions in LDL-C levels (RR = 52.33, 95% CI 18.51–147.95, &lt;i&gt;p&lt;/i&gt; value &lt; 0.00001, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%) and LDL-C &lt; 1.8 mmol/L (RR = 17.27, 95% CI 9.59–31.11, &lt;i&gt;p&lt;/i&gt; value &lt; 0.00001, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%) at week 12 in the tafolecimab group than the placebo group. Additionally, tafolecimab also caused a robust decrease in non-HDL-C, apolipoprotein B, and lipoprotein(a) levels from baseline to week 12 compared to placebo. The overall risk of bias was low, as determined by the RoB 2 tool.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Tafolecimab showed promising lipid-lowering efficacy and a well-tolerated safety profile. Our findings suggest its potential as an innovative therapeutic option for individuals with hypercholesterolemia; however, significant heterogeneity was observed in some results, making it difficult to come to a firm conclusion. Therefore,","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"641 - 650"},"PeriodicalIF":2.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategy for an early simultaneous introduction of four-pillars of heart failure therapy: results from a single center experience","authors":"Paolo Severino,&nbsp;Andrea D’Amato,&nbsp;Silvia Prosperi,&nbsp;Marco Valerio Mariani,&nbsp;Vincenzo Myftari,&nbsp;Aurora Labbro Francia,&nbsp;Claudia Cestiè,&nbsp;Elisa Tomarelli,&nbsp;Giovanna Manzi,&nbsp;Lucia Ilaria Birtolo,&nbsp;Stefanie Marek-Iannucci,&nbsp;Viviana Maestrini,&nbsp;Massimo Mancone,&nbsp;Roberto Badagliacca,&nbsp;Francesco Fedele,&nbsp;Carmine Dario Vizza","doi":"10.1007/s40256-024-00660-6","DOIUrl":"10.1007/s40256-024-00660-6","url":null,"abstract":"<div><h3>Introduction</h3><p>The 2021 European Society of Cardiology (ESC) Guidelines recommend the use of four different classes of drugs for heart failure with reduced ejection fraction (HFrEF): beta blockers (BB), sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin receptor/neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRAs). Moreover, the 2023 ESC updated Guidelines suggest an intensive strategy of initiation and rapid up-titration of evidence-based treatment before discharge, based on trials not using the four-pillars. We hypothesized that an early concomitantly administration and up-titration of four-pillars, compared with a conventional stepwise approach, may impact the vulnerable phase after hospitalization owing to HF.</p><h3>Methods</h3><p>This prospective, single center, observational study included consecutive in-hospital patients with HFrEF. After performing propensity score matching, they were divided according to treatment strategy into group 1 (G1), with predischarge start of all four-pillars, with their up-titration within 1 month, and group 2 (G2) with the pre Guidelines update stepwise four-pillars introduction. HF hospitalization, cardiovascular (CV) death, and the composite of both were evaluated between the two groups at 6-month follow-up.</p><h3>Results</h3><p>The study included a total of 278 patients who completed 6-month follow-up (139 for both groups). There were no differences in terms of baseline features between the two groups. At survival analysis, HF hospitalization risk was significantly lower in G1 compared with G2 (<i>p</i> &lt; 0.001), while no significant differences were observed regarding CV death (<i>p</i> = 0.642) or the composite of CV death and HF hospitalization (<i>p</i> = 0.135).</p><h3>Conclusions</h3><p>In our real-world population, patients with HF treated with a predischarge and simultaneous use of four-pillars showed a reduced risk of HF hospitalization during the vulnerable phase after discharge, compared with  a conventional stepwise approach. </p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 5","pages":"663 - 671"},"PeriodicalIF":2.8,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141439989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ongoing and Future Clinical Trials of Pharmacotherapy for Heart Failure","authors":"Taha Mansoor,&nbsp;Subaina N. Khalid,&nbsp;Muhammad Ibraiz Bilal,&nbsp;Sardar Hassan Ijaz,&nbsp;Marat Fudim,&nbsp;Stephen J. Greene,&nbsp;Haider J. Warraich,&nbsp;Vijay Nambi,&nbsp;Salim S. Virani,&nbsp;Gregg C. Fonarow,&nbsp;Dmitry Abramov,&nbsp;Abdul Mannan Khan Minhas","doi":"10.1007/s40256-024-00658-0","DOIUrl":"10.1007/s40256-024-00658-0","url":null,"abstract":"<div><p>Increasing knowledge of the processes leading to heart failure (HF) has allowed significant developments in therapies for HF over the past few decades. Despite the evolution of HF treatment, it still places a large burden on patients and health care systems across the world.</p><p>We used clinicaltrials.gov to gather information about clinical trials as of August 2023 studying pharmacotherapy for HF. We included interventional trials that were “<i>active, not recruiting</i>”, “<i>recruiting</i>”, or looking for participants but “<i>not yet recruiting</i>”. In total, 119 studies met our criteria of ongoing clinical trials studying novel as well as currently approved HF pharmacotherapies. The major interventions were novel medications/already approved medications for other diseases 29 % (34 trials), sodium-glucose co-transporter inhibitors 21 % (25 trials), angiotensin receptor blocker-neprilysin inhibitors 10 % (12 trials), diuretics 14 % (17 trials) and mineralocorticoid receptor antagonists 5 % (6 trials). Ongoing research will aid in reducing the impact of HF and we summarize clinical trials leading the way to better HF treatment in this review.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"481 - 504"},"PeriodicalIF":2.8,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141439988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Prolonged Dual Antiplatelet Therapy After Bifurcation Percutaneous Coronary Intervention in Patients with High Ischemic Risk","authors":"Dmitrii Khelimskii,&nbsp;Ivan Bessonov,&nbsp;Stanislav Sapozhnikov,&nbsp;Aram Badoyan,&nbsp;Aleksey Baranov,&nbsp;Mahmudov Mamurjon,&nbsp;Serezha Manukian,&nbsp;Ruslan Utegenov,&nbsp;Oleg Krestyaninov","doi":"10.1007/s40256-024-00657-1","DOIUrl":"10.1007/s40256-024-00657-1","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study was to evaluate the impact of prolonged dual antiplatelet therapy (DAPT) on clinical outcomes in patients undergoing percutaneous coronary interventions (PCI) for bifurcation coronary lesions.</p><h3>Methods</h3><p>A total of 1000 patients who underwent PCI for coronary bifurcation lesions and had clinical follow-up were divided into two groups based on the duration of DAPT: DAPT &gt; 12 months and DAPT ≤ 12 months). Patients who experienced a myocardial infarction, required repeat PCI, or died within 1 year after the initial procedure were excluded.</p><h3>Results</h3><p>Among the 1000 eligible patients, 394 patients received DAPT for &gt; 12 months (39.4%). Most patients in our study presented with chronic coronary disease (61%). The majority of patients in our study (62.8%) had a low bleeding risk. The median follow-up duration was 35 months (interquartile range 20.6–36.5). There were no significant differences in the major adverse cardiovascular events (MACE) between groups of prolonged DAPT (&gt; 12 month) and DAPT ≤ 12 months (18.8% vs. 14.9%, <i>p</i> = 0.11). Patients with clinical features of high ischemic risk (HIR) had a significantly increased risk of MACE (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.12–3.26, <i>p</i> = 0.015) when compared with patients without clinical features of HIR. Compared with DAPT ≤ 12 months, extended DAPT (&gt; 12 months) did not improve outcomes in patients with clinical (HR 1.24, 95% CI 0.90–1.72, <i>p</i> = 0.19) and technical features (HR 1.04, 95% CI 0.67–1.63, <i>p</i> = 0.85) of HIR.</p><h3>Conclusion</h3><p>In this multicenter real-world registry, administration of DAPT for more than 12 months in patients who have undergone PCI for bifurcation lesion is not associated with a reduced incidence of MACE in long-term follow-up.</p><h3>Registration</h3><p>ClinicalTrials.gov identifier no. NCT03450577.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"577 - 588"},"PeriodicalIF":2.8,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards the Fifth Pillar for the Treatment of Heart Failure with Reduced Ejection Fraction: Vericiguat in Older and Complex Patients","authors":"Luigi Spadafora,&nbsp;Marco Bernardi,&nbsp;Gianmarco Sarto,&nbsp;Beatrice Simeone,&nbsp;Maurizio Forte,&nbsp;Luca D’Ambrosio,&nbsp;Matteo Betti,&nbsp;Alessandra D’Amico,&nbsp;Vittoria Cammisotto,&nbsp;Roberto Carnevale,&nbsp;Simona Bartimoccia,&nbsp;Pierre Sabouret,&nbsp;Giuseppe Biondi Zoccai,&nbsp;Giacomo Frati,&nbsp;Valentina Valenti,&nbsp;Sebastiano Sciarretta,&nbsp;Erica Rocco","doi":"10.1007/s40256-024-00652-6","DOIUrl":"10.1007/s40256-024-00652-6","url":null,"abstract":"<div><p>Heart failure with reduced ejection fraction (HFrEF) represents an emerging epidemic, particularly affecting frail, older, and multimorbid patients. Current therapy for the management of HFrEF includes four different classes of disease-modifying drugs, commonly referred to as ‘four pillars’, which target the neurohormonal system that is overactivated in HF and contributes to its progression. These classes of drugs include β-blockers, inhibitors of the renin-angiotensin-aldosterone system, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter-2 (SGLT2) inhibitors. Unfortunately, these agents cannot be administered as frequently as needed to older patients because of poor tolerability and comorbidities. In addition, although these drugs have dramatically increased the survival expectations of patients with HF, their residual risk of rehospitalization and death at 5 years remains considerable. Vericiguat, a soluble guanylate cyclase (sGC) stimulator, was reported to exert beneficial effects in patients with worsening HF, including older subjects, reducing the rate of both hospitalizations and deaths, with limited adverse effects and drug interaction. In this narrative review, we present the current state of art on vericiguat, with a particular focus on elderly and frail patients.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"469 - 479"},"PeriodicalIF":2.8,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141295356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}