American Journal of Cardiology最新文献

{"title":"\"Evolving Trends of Hypertension and Cerebral Infarction-Related Mortality in the United States from 2000-2020\".","authors":"Iftikhar Khan, Maryam Athar, Mohammad Ahmad, Eshal Amir, Anas M Din Bashir, Syeda Rida Abdi, Rafay Omar Farooq, Muhammad Usaid, Nashrah Adnan, Muhammad Taha Altaf, Subahat Huma, Tania Ijaz","doi":"10.1016/j.amjcard.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.032","url":null,"abstract":"<p><p>Cerebral infarction remains a major health burden for the US population, with hypertension as its leading risk factor. However, its mortality trends remain understudied. Analyzing these trends helps identify high risk populations and shape future public health strategies. The study aimed to analyze the demographic and regional mortality trends and disparities of hypertension related cerebral infarction in the US population from 2000-2020. CDC Wonder database was utilized to extract death certificate data for hypertension-related cerebral infarction from 2000-2020. Crude mortality rates and Age adjusted mortality rate (AAMR) were calculated per 100,000. Joint point regression determined APC and 95% CI. Data was categorized by gender, sex, age, race / ethnicity, urbanization, census region and location of death. About 111,398 hypertension related cerebral infarction deaths occurred in the US between 2000-2020. The overall AAMR declined till 2014 followed by a nonsignificant increase in slope from 2014-2017 (APC: 27.9, 95% CI: -4.3 to 70.9) and significant increase from 2017-2020 (APC: 10.7; 95% CI: 0.6 to 21.8). Women initially had higher AAMR, but rates later increased in men. Non-Hispanic (NH) Blacks and the South showed increased AAMR. And compared to urban areas, rural areas had higher mortality trends. Most deaths occurred in medical facilities followed by nursing homes, homes, and hospices. In conclusion, the mortality declined till 2014 then increased later on with significantly higher rates in men, NH Blacks, the South and the rural areas highlighting the need to improve health care system.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205429","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":"The Impact of Comorbidity Patterns on Clinical Outcomes in Heart Failure: A Machine Learning-Based Cluster Analysis.","authors":"Bingxin Liu, Yimei Zhong, Xuan Yin, Ruijian Huang, Cheng Xie, Jifang Zhou","doi":"10.1016/j.amjcard.2025.09.044","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.044","url":null,"abstract":"<p><p>Heart failure (HF) is a major global health burden, and complex comorbidity patterns can worsen clinical outcomes and complicate patient care. This study aimed to identify distinct comorbidity-based clusters among HF patients and evaluate their associations with short-term clinical outcomes. We analyzed electronic health records from 1,010,573 HF patients in China between 2021 and 2024 and classified into five distinct clusters using the Clustering Large Applications (CLARA) algorithm. Cluster 5, characterized by the highest comorbidity burden, was associated with an increased risk of 30-day readmission (adjusted OR: 1.29, 95% CI: 1.25-1.33), whereas Clusters 2 and 3 demonstrated lower risks compared with the reference group. XGBoost achieved the best predictive performance among multiple machine learning models (area under the receiver operating characteristic curve 0.76; Brier score 0.17). Age and Charlson Comorbidity Index score were the most influential predictors, and features derived from the comorbidity clusters provided additional predictive value. In conclusion, these findings demonstrate substantial heterogeneity among HF patients, highlight the clinical relevance of comorbidity-based clustering, and suggest its potential to improve risk stratification and personalized care strategies.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197914","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":"Alcohol and Cardiovascular Disease.","authors":"Shyla Gupta, Nilah Ahimsadasan, Kavi Dalsania, Leo Jing, Hamza Waraich, Kavi Gupta, Margo Kaminska, Saad Balamane, Sebastian Garcia-Zamora, Andres F Miranda-Arboleda, Juan Farina, Adrian Baranchuk","doi":"10.1016/j.amjcard.2025.09.035","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.035","url":null,"abstract":"<p><p>Alcohol's impact on cardiovascular health is biphasic: low-to-moderate intake may appear protective, but excessive or binge drinking causes significant harm. This review examines mechanisms linking overconsumption to cardiovascular disease. Acute heavy drinking can trigger \"Holiday Heart Syndrome,\" a transient atrial arrhythmia from electrophysiological instability, autonomic imbalance, and electrolyte shifts. Chronic excess contributes to alcoholic cardiomyopathy via oxidative stress, mitochondrial dysfunction, and impaired calcium handling. Alcohol also promotes atrial fibrillation and hypertension by inducing atrial fibrosis, neurohormonal dysregulation, and endothelial injury. Excessive intake accelerates coronary artery disease and type 2 diabetes through dyslipidemia, vascular inflammation, and insulin resistance, raising risks of stroke, heart failure, and myocardial infarction. While moderate consumption was once thought cardioprotective, emerging evidence-especially for atrial fibrillation-suggests risks may outweigh benefits. In conclusion, public health guidance increasingly emphasizes moderation, individualized assessment, and avoiding binge patterns, particularly for those with underlying cardiovascular vulnerabilities.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197949","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":"Causes of In-Hospital Death in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in Beijing Area.","authors":"Jing Li, Yinghua Zhang, Yixin Ma, Jinghao Sun, Xiaojie Li, Buxing Chen, Hui Chen, Peng Dong, Jingxuan Guo, Lijun Guo, Hengjian Hao, Hanhua Ji, Kang Li, Hongxu Liu, Shuzheng Lv, Luhua Shen, Zhujun Shen, Guohong Wang, Lefeng Wang, Lei Wang, Mengyue Yu, Fuchun Zhang, Haibin Zhang, Jianjun Zhang, Xingshan Zhao, Yuejin Yang","doi":"10.1016/j.amjcard.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.030","url":null,"abstract":"<p><p>This study aimed to identify causes of in-hospital death in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PPCI) in the Bejing metropolitan area.A total of 56,763 PPCIs were performed at 56 eligible hospitals between January 1, 2010, and December 31, 2018, among which 1,278 patients died. Causes of death were analyzed and finally adjudicated by a review board. The overall in-hospital mortality rate was 2.25%, ranging annually from 1.96% to 2.48% over the study period. Of these, 1069 (83.6%) deaths were attributed to disease severity-related causes, mainly cardiogenic shock of 44.4%, mechanical complications of 15.2%, malignant arrhythmia of 8.1% and heart failure of 6.2%. Another 209 (16.4%) patients died from PPCI-related complications, including coronary no-reflow of 8.5%, stent thrombosis of 3.5%, and PPCI-related bleeding of 2.4%. The incidence of PPCI-related death has decreased from 1.02% in 2010 to 0.15% in 2018 (P<.001). Hospitals in the highest quartile PPCI volume (>130 PPCI annually) had lower incidence of in-hospital death (1.97% vs. 2.62%, 2.99% and 2.56%, P<.001), disease severity-related death (1.66% vs. 2.13%, 2.4% and 2.17%, P<.001) and PPCI-related death (0.31% vs. 0.48%, 0.59% and 0.39%, P=.003), as compared to those with the first, second and third quartiles of annual PPCI volume. In conclusion,among patients with STEMI and treated with PPCI, in-hospital mortality keeps at a relatively low level in Beijing area. Most deaths are due to pathophysiological deteriorations following STEMI. Hospital PPCI volume remains serve as an important indicator for quality of care.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190652","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":"Application of the J-CTO Score to Recanalization for In-Stent Chronic Total Occlusions.","authors":"Chieh-Yu Chen, Chi-Hung Huang, Jen-Fang Cheng, Chien-Lin Lee, Jiun-Yang Chiang, Shih-Chi Liu, Chi-Jen Chang, Chia-Pin Lin, Cheng-Ting Tsai, Jun-Ting Liou, Chia-Ti Tsai, Yi-Chih Wang, Juey-Jen Hwang","doi":"10.1016/j.amjcard.2025.09.034","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.034","url":null,"abstract":"<p><p>The application of the J-CTO score for in-stent chronic total occlusion (CTO) recanalization remains unclear. We aimed to compare the role of J-CTO score in in-stent and de novo CTO interventions using wiring-based intraplaque tracking techniques. The application of the J-CTO score to assess procedural feasibility and guidewire crossing time for in-stent (N=74, 14.6%) and de novo CTO (N=434, 85.4%) interventions were evaluated in consecutive 508 patients (64.1±11.6 years, 446 men). Failed intraplaque tracking (N=3) or guidewires crossing (N=35) was considered procedural failures (38/508=7.5%). The procedural success rate for de novo CTOs significantly declined when the J-CTO score was ≥3 (85 vs. ≤2: 97%, p<0.001), but was comparable for in-stent CTOs (≥3: 96 vs. ≤2: 100%, p=0.400). Among 470 patients with successful recanalization, the guidewire crossing time ≥30 minutes was required less for in-stent than for de novo CTOs (OR=0.40, 95% CI=0.18-0.86) with J-CTO score ≥2 in multivariate analysis. For those with successful antegrade-only wiring, the guidewire crossing time shown by Kaplan-Meier curves was significantly related to the J-CTO score for either in-stent (N=72) or de novo (N=370) CTOs (both p<0.001 by log-rank test). However, only blunt stump (15.0±5.6 min) and occlusion ≥20mm (16.2±5.6 min) were independent time-determining factors of guidewire crossing (both p<0.01) for in-stent CTOs. In conclusion, with the intraplaque guidewire tracking techniques, the effects of the J-CTO score on procedural feasibility and guidewire crossing time differ for in-stent and de novo CTOs. Therefore, the J-CTO score should be cautiously interpreted during in-stent CTO interventions.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190597","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 Effectiveness of Prasugrel versus Ticagrelor in Dialysis-Dependent end stage renal disease Patients Undergoing Percutaneous Coronary Intervention.","authors":"Usman Ali Akbar, Waleed Alruwaili, Jordan L Lacoste, Harshith Thyagaturu, Sittinun Thangjui, Amro Taha, Sudarshan Balla","doi":"10.1016/j.amjcard.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.033","url":null,"abstract":"<p><p>End-stage renal disease (ESRD) patients undergoing percutaneous coronary intervention (PCI) represent a high-risk, understudied population in whom optimal P2Y₁₂ inhibition remains undefined. Landmark trials demonstrated the superiority of prasugrel and ticagrelor over clopidogrel; however, ESRD patients were largely excluded. We aimed to compare the effectiveness and safety of prasugrel versus ticagrelor in a real-world cohort of dialysis-dependent ESRD patients undergoing PCI. Using a large US-based electronic health record network, we identified 920 propensity-score matched pairs of ESRD patients on dialysis who received either prasugrel or ticagrelor following PCI between 2011 and 2024. The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), or stroke, defined as Major Adverse Cardiovascular Events (MACE). Over a median follow-up duration of 11.2 months, prasugrel was associated with a significantly lower risk of all-cause mortality (Hazard Ratio [HR] 0.72, 95% Confidence Interval [CI] 0.56-0.92, p=0.025) compared to ticagrelor. There were no significant differences in the rates of MI, stroke, or major bleeding between the two groups, although there was a trend toward lower major bleeding with prasugrel (p=0.06). In conclusion, in this large, real-world study of ESRD patients on dialysis undergoing PCI, prasugrel was associated with a lower risk of all-cause mortality compared to ticagrelor, without an increased risk of major bleeding.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190594","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":"GLP-1 Receptor Agonists and Cardiovascular Outcomes in Adults with Diabetes and Peripheral Artery Disease: An Updated Systematic Review and Meta-Analysis.","authors":"Syed Hasan Shuja, Muhammad Hamza Shuja, Ayesha Shaukat, Ramish Hannat, Ilsa Ahmed, Siad Adam, Ahmed Abdelkhalek, Mah I Kan Changez, Irfan Ullah, Raheel Ahmed, Bernardo Cortese","doi":"10.1016/j.amjcard.2025.09.039","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.039","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide proven cardiovascular benefits in type 2 diabetes mellitus (T2DM) and heart failure, but their effects in patients with peripheral artery disease (PAD) remain unclear. PAD is common in T2DM and increases the risk of adverse cardiovascular and limb outcomes. This meta-analysis assessed the impact of GLP-1 RAs on cardiovascular and limb-related outcomes in patients with T2DM and PAD. A systematic search of PubMed, Cochrane CENTRAL, ScienceDirect, and ClinicalTrials.gov was conducted through May 24, 2025. Primary outcomes included all-cause mortality (ACM) and cardiovascular mortality (CVM). Secondary outcomes were major adverse cardiovascular events (MACE),), myocardial infarction, stroke, major adverse limb events (MALE), glycemic control (HbA1c), body weight, and adverse events. Pooled risk ratios and mean differences were calculated using random-effects models. Six randomized controlled trials, including 7,645 participants met the inclusion criteria. GLP-1 RAs significantly reduced ACM (RR 0.83, 95% CI 0.70-0.99, p = 0.04, I² = 0%), MACE (RR 0.86, 95% CI 0.76-0.98, p = 0.02, I² = 0%), and improved HbA1c (MD -0.72%, p = 0.02), with no significant effect on weight, MALE, CVM, myocardial infarction, or stroke. In conclusion, GLP-1 RAs lower MACE and ACM in patients with T2DM and PAD but do not clearly benefit limb-specific outcomes, highlighting the need for larger, PAD-focused trials to clarify their role in limb protection.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190666","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":"Survey Study to Differentiate Vasospastic Angina from Coronary Microvascular Dysfunction in Real-World Management of Ischemia with Non-Obstructive Coronary Artery Disease.","authors":"Shuhei Odagiri, Yoshihiro Motozawa, Satoru Hashimoto","doi":"10.1016/j.amjcard.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.031","url":null,"abstract":"<p><p>The appropriate management of ischemia with non-obstructive coronary artery disease (INOCA) has now become a globally recognized issue. However, there is a lack of studies examining how cardiologists manage INOCA by differentiating between vasospastic angina and coronary microvascular dysfunction (CMD) endotypes in real clinical practice, as well as the extent to which they are satisfied with their current diagnostic and management approaches. This survey collected data through a web-based questionnaire conducted between October 15, 2024, and November 15, 2024, targeting Japanese cardiologists who were members of a cardiology-specific website. In total, 158 cardiologists responded to the survey. Approximately 54% of the cardiologists reported having clinical experience with <10 INOCA patients. Only 15% reported being very satisfied or satisfied with the management of INOCA. Cardiologists prescribing or recommending beta-blockers for CMD endotype patients exhibited significantly higher odds of INOCA management satisfaction (OR, 3.80; 95% CI: 1.38-11.2; p = 0.0047). Furthermore, specialization in interventional cardiology was associated with increased odds (OR, 5.97; 95% CI: 1.67-32.7; p = 0.0016), and satisfied cardiologists were significantly more likely to pay more attention to the presence of CMD (p = 0.017) and order physiological assessments (p = 0.026). Although awareness of INOCA is growing, overall satisfaction with its clinical management remains low among cardiologists. Those who are more attentive to CMD and differentiate among INOCA subtypes tend to report higher satisfaction. In conclusion, these findings highlight the need for additional research and better dissemination of diagnostic and treatment strategies to improve quality of care.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190673","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":"Predictors of permanent pacemaker implantation in patients with raphe-type bicuspid aortic valve stenosis undergoing TAVR.","authors":"Antonio Mangieri, Mauro Gitto, Giuseppe Tarantini, Won-Keun Kim, Tommaso Fabris, Chiara de Biase, Michele Bellamoli, Nicholas Montarello, Giuliano Costa, Mesfer Alfadhel, Ofi Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Andrea Scotti, Lin Bai, Giulia Costa, Alessandro Mazzapicchi, Enrico Giacomin, Riccardo Gorla, Karsten Hug, Carlo Briguori, Luca Bettari, Antonio Messina, Mauro Boiago, Matthias Renker, Mario Garcia Gomez, Chiara Fraccaro, Maria Luisa De Rosa, Andrea Zito, Carlo Trani, Giulia Laterra, Dario Pellegrini, Alfonso Ielasi, Ady Orbach, Uri Landes, Tobias Rheude, Luca Testa, Ignacio Amat Santos, Francesco Saia, Luca Favero, Mao Chen, Marianna Adamo, Azeem Latib, Anna Sonia Petronio, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Francesco Burzotta, Marco Barbanti, Ole De Backer, Didier Tchètchè, Diego Maffeo, Andrea Buono","doi":"10.1016/j.amjcard.2025.09.042","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.042","url":null,"abstract":"<p><strong>Unstructured abstract: </strong>There are limited data regarding predictors and impact of permanent pacemaker implantation (PPI) among patients with raphe-type bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim is to evaluate the incidence, predictors and clinical impact of PPI among patient with raphe-type BAV treated with TAVR. The AD-HOC is an international registry enrolling patients with raphe-type BAV stenosis undergoing TAVR. We investigated the incidence of PPI; clinical, anatomical and procedural predictors of PPI were assessed. The impact of PPI on overall survival and on the Valve Academic Research Consortium-3 (VARC-3) clinical efficacy endpoint, defined as freedom from death, heart failure (HF) hospitalizations or TIA/stroke, was evaluated. Among the 912 patients, PPI after TAVR was required in 141 cases (15.5%). The VARC-3 technical success and device success endpoints were met in 94.7% and 85.2% of patients with no differences between those with and without PPI. Independent predictors of PPI included peripheral vascular disease (OR: 2.05, 95% CI: 1.09-3.87, p=0.026), chronic kidney disease (OR: 1.53, 95% CI: 1.04-2.26), right bundle branch block (RBBB - OR: 5.88, 05% CI: 3.33-10.38), R-L raphe localization (OR: 2.51, 95% CI: 1.24, 5.10) and use of Evolut R/Pro/Pro+ (OR: 1.68, 95% CI: 1.18-2.68, p=0.006). At follow-up, VARC-3 clinical efficacy endpoint was similar (log-rank p=0.579). In conclusions, PPI following TAVR in BAV is relatively common but without impact on mid-term clinical outcome. Beyond pre-procedural RBBB and the use of Evolut valves, PPI had unique anatomical predictors within this population, such as the R-L raphe localization.</p><p><strong>Condensed abstract: </strong>The AD-HOC is an observational, international, multicenter registry enrolling patients with raphe-type 1 BAV stenosis undergoing TAVR at 24 Institutions from 2016 to 2023. Among the 912 included patients, new PPI was required in 141 cases (15.5%). The VARC-3 technical success and device success endpoints were met in 94.7% and 85.2% of patients, respectively, with no differences between those with and without PPI. At multivariable logistic regression analysis, independent predictors of PPI after TAVR included peripheral vascular disease, chronic kidney disease, pre-procedural RBBB, the R-L raphe localization and the use of Evolut R/Pro/Pro+ valves. No differences were noticed between PPI and no-PPI recipients in terms of the VARC-3 efficacy endpoint at the 3-year follow-up.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190620","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":"Effects of Renin-Angiotensin-Aldosterone System Inhibitor Discontinuation after Acute Kidney Injury on Mortality: A Retrospective Analysis.","authors":"Daniel Feldman, Bryce Grohol, Vincent Mack, Matthew Langston, Lianteng Zhi, Dina Murad, Zaid Ammari","doi":"10.1016/j.amjcard.2025.09.043","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.043","url":null,"abstract":"<p><p>Guideline directed medical therapy to include renin-angiotensin-aldosterone inhibitors (RAASi) has led to a significant reduction in heart failure mortality. These medications, however, are often discontinued on admission for an acute kidney injury and never restarted. The impact of this discontinuation on mortality is unknown. This retrospective, propensity matched, analysis between 2016 and 2021 sought to examine the impact that discontinuation of RAASi, after an acute kidney injury, has on one year mortality in patients with heart failure. Data were obtained using the electronic health record of a tertiary care health system in the United States. The exposure was whether the patient's RAASi was discontinued on discharge and the outcome was one year mortality. We found that, among patients admitted for an acute kidney injury with heart failure who were on an RAASi at the time of admission (n = 512), discontinuation of the patient's RAASi on discharge was associated with 1.96 times as many deaths at one year (OR 1.96, 95% CI 1.28 - 2.99, p < 0.001) compared to those who were continued on their RAASi. These findings emphasize the potential impact on patient outcomes and the importance of optimizing treatment regimens in this high-risk population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190600","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}