American Journal of Cardiology最新文献

{"title":"In-Hospital Mortality After Aortic Valve Replacement Surgical Versus Transcatheter: A Nationwide Study with Machine Learning-Based Risk Prediction.","authors":"Akash Sharma, Mohamed Jamshid Ubaid, Fnu Shalini, Hamza Yousaf","doi":"10.1016/j.amjcard.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.003","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are two preferred methods for treating aortic stenosis. This study compared the in-hospital mortality rates associated with SAVR and TAVR.</p><p><strong>Methods: </strong>In accordance with the STROBE guidelines, we conducted an analytical cross-sectional study utilizing data from the National Readmission Database (NRD) spanning from 2016 to 2020. Patients who underwent TAVR or SAVR were identified using specific ICD-10 procedure codes. We employed adjusted multivariate logistic regression analysis to determine the odds ratio (OR) of death associated with SAVR compared to TAVR. Patients were followed for a year and OR with 95% CI were calculated. AI based XGBoost model were used to find the predictors of mortality.</p><p><strong>Results: </strong>Our study included a total of 361,875 patients. Among these, 182,443 underwent TAVR, while 179,432 underwent SAVR. In the TAVR group, 2,563 patients (1.4%) died during hospitalization, whereas 6,671 patients (3.7%) died in the SAVR group. The multivariate logistic regression analysis indicated that SAVR is associated with higher in-hospital mortality (OR = 2.66, 95% CI 2.51-2.81, p < 0.001) compared to TAVR. Follow up data at 30 days, three months, six months, did not find any difference in mortality between TAVR and SAVR. Notably, liver failure, HLD, renal failure, SAVR, female, CHF, and atrial fibrillation are amongst the top predictor of mortality in patients undergoing (TAVR or SAVR). While in cardiac rehospitalization, risk factors like female gender, CHF, Afib, HLD, DM have higher predictability than procedure.</p><p><strong>Conclusion: </strong>Our study demonstrates that SAVR is associated with a higher likelihood of in-hospital mortality compared to TAVR, with organ dysfunction (liver failure, kidney dysfunction) as a predictor of mortality.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Vessel Preparation in Femoropopliteal Lesions: Does the Chocolate Balloon Deliver on Its Clinical Promise?","authors":"Luca Golino","doi":"10.1016/j.amjcard.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.016","url":null,"abstract":"<p><p>The \"leave nothing behind\" paradigm using drug-coated balloons (DCBs) has reshaped femoropopliteal peripheral artery disease treatment, though clinical success remains heavily contingent upon optimal vessel preparation. In a recent issue of The American Journal of Cardiology, Li and colleagues address the limitations of conventional plain old balloon angioplasty (POBA) through a propensity score-matched analysis of 508 patients from the multicenter PROMISING registry, comparing specialized vessel preparation using the nitinol-constrained Chocolate balloon against POBA prior to DCB angioplasty. The Chocolate balloon significantly reduced the primary endpoint of bailout stenting (20.47% vs. 29.92%) and facilitated larger final DCB diameters, though these acute mechanical advantages did not translate into statistically significant differences in clinical outcomes at 12 months. This commentary examines this striking \"procedural-to-clinical paradox,\" highlighting how the potent antiproliferative effect of DCBs and the acute compensatory function of bailout stents may temporarily mask early clinical divergence. Given that cumulative mechanical failures of permanent metallic implants typically emerge beyond one year in hostile biomechanical environments, longer-term observation remains essential to capture the true clinical dividend of a stent-free strategy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Guideline-Recommended Genetic Testing in Patients at Risk for Heritable Thoracic Aortic Disease.","authors":"Ariadna Robledo, Sean O'Leary, Daniel Del Toro Pedrosa, Jorge Penalver, Rhea Sancassani","doi":"10.1016/j.amjcard.2026.10.012","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.012","url":null,"abstract":"<p><p>Heritable thoracic aortic diseases (HTAD) include genetic conditions that increase risk of thoracic aortic aneurysm and dissection. The 2022 American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend genetic testing for at-risk individuals, but real-world uptake remains unclear. We evaluated adherence to testing recommendations and demographic differences across major HTAD risk cohorts. We conducted a retrospective study using the TriNetX Research Network (2005-2025). Three guideline-based cohorts were identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes: (1) thoracic aortic aneurysm/dissection before age 60, (2) family history of thoracic aortic disease, and (3) non-thoracic arterial aneurysms. Genetic testing was defined by ICD-10-CM codes for genetic screening or susceptibility. Testing prevalence was stratified by age, sex, race, and ethnicity, and annual testing incidence (2005-2024) was evaluated. Among 57,935 patients with thoracic aortic aneurysm/dissection before age 60, 1,205 (2.09%) underwent genetic testing. Among 2,811,862 patients with a family history of thoracic aortic disease, 66,699 (2.38%) received testing. Among 347,000 patients with non-thoracic arterial aneurysms, 4,913 (1.42%) underwent testing. Testing was consistently higher in females than males and varied across age groups. Annual testing incidence increased over time but remained <0.6% by 2024. In conclusion, genetic testing for HTAD remains markedly underutilized, with < 2.5% of at-risk patients tested despite guideline recommendations, highlighting persistent implementation gaps and the need to improve equitable access to genetic evaluation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive Left Ventricular End Diastolic Wall Stress and the Risk of Incident Heart Failure in a Clinical Population.","authors":"Audrey White, Jeffrey Annis, Shi Huang, Debra D Dixon, Kelly Schlendorf, Evan BrittainMSCI, Deepak K Gupta","doi":"10.1016/j.amjcard.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.014","url":null,"abstract":"<p><p>Greater left ventricular (LV) wall stress has been associated with adverse clinical outcomes among patients with heart failure (HF). We examined the relation between LV wall stress and the risk of incident HF. Using data from the Vanderbilt Synthetic Derivative, we studied 29,246 adult patients without prevalent HF or ≥ moderate valve disease who underwent transthoracic echocardiography between 2014-2020. LV end diastolic wall stress (LVEDWS) was calculated from chamber and wall thickness measures and E/e' as a surrogate for LV end diastolic pressure. Incident HF was ascertained from ICD-9/10 codes. Correlates of LVEDWS were examined with multivariable linear regression. The association between LVEDWS and risk of incident HF was tested in Cox regression adjusted for demographics, comorbidities, blood pressure, body mass index, laboratory data including B-type natriuretic peptide, LVEF, and LV mass index. The cohort had a median age of 59 years, 54% females, with 11% of individuals identifying as Black. Median LVEDWS was 14.5 (IQR: 11.8-18.0) kdynes/cm². Cross sectional correlates of LVEDWS ranked according to Chi-squared value were LVEF, heart rate, female sex, and LV mass index. Over a maximum follow-up time of 8.2 years (median 3.7 years), 3,082 (11%) individuals developed incident HF. In multivariable Cox regression, each 1-unit increase in LVEDWS significantly associated with an increased risk of incident HF (aHR: 1.019; 95%CI 1.014-1.024), which was largely consistent across subgroups. In conclusion, among a broad range of patients clinically referred for echocardiography, greater non-invasively measured LVEDWS associates with higher risk for incident HF.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence on Valve Selection for Small Aortic Annuli in Transcatheter Aortic Valve Replacement.","authors":"Adnaldo Da Silveira Maia, Gabriel Neves, Usman Aliyu, Ahmet Kilic, Michel Pompeu Sá","doi":"10.1016/j.amjcard.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.009","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement in patients with small aortic annuli presents unique challenges related to prosthesis-patient mismatch, residual gradients, conduction disturbances, and lifetime valve management. Recent observational data have suggested potential differences in mid-term survival between self-expanding valve and balloon-expandable valve platforms; however, these findings have not been consistently supported by other observational studies or long-term randomized evidence. Importantly, both severe prosthesis-patient mismatch and permanent pacemaker implantation may carry prognostic implications, underscoring the competing risks involved in valve selection. In conclusion, current evidence does not establish the clinical superiority of one transcatheter valve platform over another, supporting an individualized approach to valve selection.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Cardiovascular Outcomes Associated with Evolocumab Versus Inclisiran Among Patients with Elevated Lipoprotein(a).","authors":"Ibrahim Mortada, Aaron W Lee, Dalton Buckingham, Grant Ebel, Nicholas Long, Jayasurya Dileep, Avinav Sanjel, Ali Al-Shammari, Thomas A Blackwell, Hani Jneid","doi":"10.1016/j.amjcard.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.010","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular Imaging in Non-Complex PCI.","authors":"Antonio Colombo, Pier Pasquale Leone","doi":"10.1016/j.amjcard.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.015","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GDMT Adherence and Arterial Grafting Strategy: Outcomes in GDMT-Compliant SIMA vs GDMT-Noncompliant BIMA CABG.","authors":"Kei Kobayashi, Xander Jacqemyn, Jianhui Zhu, Floyd W Thoma, Derek Serna-Gallegos, David Kaczorowski, Johannes Bonatti, Francis Ferdinand, David West, Takuya Ogami, Nathan J Chu, Irsa Hasan, Danny Chu","doi":"10.1016/j.amjcard.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.013","url":null,"abstract":"<p><strong>Background: </strong>The interaction between conduit strategy and longitudinal guideline-directed medical therapy (GDMT) adherence remains unclear.</p><p><strong>Objectives: </strong>To compare long-term outcomes between patients who underwent GDMT-compliant single internal mammary artery (SIMA) grafting and GDMT-noncompliant bilateral internal mammary artery (BIMA) grafting in isolated primary coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Adults ≥18 years of age who underwent isolated CABG with SIMA or BIMA between 2011-2024 were retrospectively analyzed. GDMT compliance was defined as ≥80% medication coverage from discharge to first major adverse cardiovascular event (MACE) or censoring (through last follow-up if no MACE). Patients were restricted to GDMT-compliant SIMA with saphenous vein grafts (cSIMA) versus GDMT-noncompliant BIMA with saphenous vein grafts (ncBIMA). Propensity-score matching (1:4) was performed. The primary endpoint was time to first MACE (all-cause mortality, myocardial infarction (MI), and repeat revascularization).</p><p><strong>Results: </strong>Matching yielded 157 ncBIMA and 618 cSIMA with similar follow-up (8.13 vs 7.62years, p=0.143). ncBIMA more often received ≥3 grafts (87.3 vs 70.6%, p<0.001). Time-to-event analyses demonstrated higher cumulative MACE in cSIMA (5-year 22.5 vs 12.1%; 10-year 39.7 vs 29.1%; log-rank p=0.0394) and higher cumulative incidence of MI hospitalization (Gray's p=0.0096) and revascularization (Gray's p=0.0028). After adjustment for pump status and graft number, cSIMA remained associated with higher hazards of MACE (HR1.54, 95%CI 1.07-2.20), MI hospitalization (HR2.10, 95%CI 1.01-4.36), and revascularization (HR3.01, 95%CI 1.50-6.03).</p><p><strong>Conclusions: </strong>Despite GDMT compliance, cSIMA was associated with higher long-term MACE than ncBIMA, driven by MI hospitalization and repeat revascularization, supporting broader consideration of BIMA in appropriately selected patients in maximizing survival benefit.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Propensity-Matched Analysis of Pre Versus Concomitant Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement With Frailty-Related High-Risk Features.","authors":"Avery Love, Duc-Hieu Bui, Shahman Shahab, Avinav Sanjel, Chandler O'Leary, Hani Jneid, Aiham Albaeni","doi":"10.1016/j.amjcard.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.011","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) is frequently performed in patients undergoing transcatheter aortic valve replacement (TAVR); however, the optimal timing of PCI remains uncertain, particularly in patients with frailty-related high-risk features. Evidence comparing pre-TAVR versus concomitant PCI strategies in this vulnerable population is limited.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Research Network to identify patients with frailty-related high-risk features undergoing TAVR with either pre-TAVR PCI (3 months to 2 weeks before TAVR) or concomitant PCI (same day as TAVR). Propensity score matching (1:1) was performed using demographics, comorbidities, frailty-related features, and antiplatelet and anticoagulant therapy. The primary outcome was a 90-day composite including all-cause mortality, acute kidney injury, bleeding requiring transfusion, gastrointestinal bleeding, intracranial hemorrhage, acute coronary syndrome, and ischemic stroke. Secondary outcomes included the composite outcome at 30 days and 1 year, as well as individual components.</p><p><strong>Results: </strong>After propensity score matching, 361 patients were included in each group with adequate baseline balance. The primary 90-day composite outcome occurred in 27.4% of patients undergoing pre-TAVR PCI and 29.4% undergoing concomitant PCI (RR 1.07, 95% CI 0.85-1.35; p=0.56). At 30 days, the composite outcome occurred in 21.9% and 24.4% of patients, respectively (RR 1.11, 95% CI 0.85-1.45; p=0.43). At 1 year, the composite outcome occurred in 37.1% of the pre-TAVR PCI group and 38.5% of the concomitant PCI group (RR 1.04, 95% CI 0.86-1.25; p=0.70). No significant differences were observed in all-cause mortality at any time point.</p><p><strong>Conclusions: </strong>Among patients with frailty-related high-risk features undergoing TAVR, pre-TAVR PCI and concomitant PCI were associated with similar short- and longer-term clinical outcomes. No significant differences were observed in the 90-day composite outcome or all-cause mortality. These findings support an individualized approach to PCI timing in frail, high-risk patients.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Socioeconomic Deprivation and Clinical Outcomes of Glucagon-Like Peptide-1 Receptor Agonists in Heart Failure.","authors":"Shaheer Qureshi, Maryam Sajid, Habib R Khan, Stephen J Greene, Marat Fudim, Gerry P McCann, Iain B Squire, Saad Ahmed Waqas, Mohammad Shahzeb Khan, Claire Lawson, Muhammad Rashid","doi":"10.1016/j.amjcard.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.10.001","url":null,"abstract":"<p><p>The impact of socioeconomic deprivation on the effectiveness and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in heart failure (HF) remains unclear. We evaluated GLP-1RA-associated outcomes across socioeconomic strata and quantified residual disparities among GLP-1RA users. Using the TriNetX Global Network (2020-2024), adults with HF initiating GLP-1RA therapy were categorized as socioeconomically deprived or non-deprived. Cohorts were 1:1 propensity-score matched within each stratum, enabling three comparisons: GLP-1RA users vs non-users in deprived patients, GLP-1RA users vs non-users in non-deprived patients, and deprived vs non-deprived among GLP-1RA users. Cox models estimated adjusted hazard ratios (aHRs) for 12-month mortality and hospitalization outcomes. Among deprived patients, GLP-1RA users (n=22,585) were compared with non-users (n=194,967); among non-deprived patients, users (n=116,439) were compared with non-users (n=2,254,050). In a direct comparison restricted to GLP-1RA users, deprived (n=21,171) and non-deprived (n=104,887) patients were analyzed. GLP-1RA therapy was associated with similar relative reductions in all-cause mortality or hospitalization in deprived (aHR 0.68, 95% CI 0.66-0.70) and non-deprived patients (aHR 0.68, 95% CI 0.67-0.69). However, deprived users had worse outcomes than non-deprived users (35.5% vs 27.1%; aHR 1.50, 95% CI 1.44-1.55), driven by higher hospitalization (aHR 1.53, 95% CI 1.48-1.58) and mortality (aHR 1.13, 95% CI 1.02-1.24). HF exacerbation (aHR 1.11) and ischemic stroke (aHR 1.16) were also increased. GLP-1RA use was associated with similar relative reductions in adverse outcomes across socioeconomic groups; however, socioeconomically deprived patients continued to experience higher absolute event rates, likely reflecting persistent baseline disparities and residual risk.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}