American Journal of Cardiology最新文献

{"title":"Impact of Pre-reperfusion Left Ventricle Unloading on ST-segment-elevation Myocardial Infarction According to the Onset-to-Unloading Time.","authors":"Naotaka Okamoto, Yasuyuki Egami, Ayako Sugino, Noriyuki Kobayashi, Masaru Abe, Mizuki Osuga, Hiroaki Nohara, Shodai Kawanami, Akito Kawamura, Kohei Ukita, Koji Yasumoto, Yasuharu Matsunaga-Lee, Masamichi Yano, Masami Nishino","doi":"10.1016/j.amjcard.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.003","url":null,"abstract":"<p><p>It is unclear whether the impact of pre-reperfusion unloading on improving survival is sustained throughout all periods from the onset in patients with ST-segment-elevation myocardial infarction (STEMI). This study is a post-hoc analysis of the J-PVAD registry. Among all patients registered in J-PVAD between February 2020 and December 2021, patients with STEMI complicated with cardiogenic shock and treated with Impella alone support were selected. Two cohorts were provided based on whether the onset-to-unloading time was < 6 hours. The patients were divided into 2 groups according to pre- or post-reperfusion unloading in each cohort. The primary outcome was a 30-day survival rate. The independent factors of survival were identified with a multivariable Cox proportional hazard regression analysis after adjusting for the variables that were statistically significant in the univariable analysis. Patients with pre-reperfusion unloading had a significantly higher 30-day survival rate than patients with post-reperfusion unloading (91% vs. 67%, p< 0.01) in the cohort with an onset-to-unloading time ≥6 hours, while patients with pre- and post-reperfusion unloading had similar 30-day survival rates (88% vs. 91%, p=0.64) in the cohort with an onset-to-unloading time <6 hours. A multivariable analysis revealed that pre-reperfusion use of Impella was an independent factor of survival (hazard ratio 0.249 [95% confidence interval 0.070-0.889], p=0.03) in the onset-to-unloading time ≥6 hours cohort. In conclusion, pre-reperfusion LV unloading could be a crucial treatment to improve the short-term survival rate when the onset-to-LV unloading time was ≥ 6 hours.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823693","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":"Meta-analysis of Intravascular Ultrasound-guided versus Angiography-guided Endovascular Treatment in Lower Extremity Artery Disease.","authors":"Jae-Sik Jang, Han-Young Jin, Young-Ah Park, Tae-Hyun Yang, Jeong-Sook Seo, Dae-Kyeong Kim, Jin-Hong Wi","doi":"10.1016/j.amjcard.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.012","url":null,"abstract":"<p><p>Intravascular ultrasound (IVUS) offers precise information about lesion morphology and enhance the optimization of endovascular treatments (EVT). Nevertheless, the impact of IVUS on the durability of EVTs and clinical outcomes remains uncertain. The aim of this systematic review and meta-analysis was to evaluate the efficacy of IVUS-guided EVT compared with angiography-guided EVT. We conducted a meta-analysis of trials comparing IVUS-guided and angiography-guided EVT. The primary endpoint was binary restenosis, while the secondary endpoints included reintervention, major amputation, death or amputation, and major adverse limb events (MALE). This meta-analysis included 19 studies with 800,452 patients. Compared to angiography-guided EVT, IVUS-guided EVT significantly reduced the risk of binary restenosis (RR: 0.63, CI: 0.43-0.91, p=0.02). It also reduced the risk of reintervention (RR: 0.59, CI: 0.39-0.90, p=0.01), major amputation (RR: 0.85, CI: 0.74-0.98, p=0.02), death or amputation (RR: 0.72, CI: 0.56-0.91, p=0.007), and MALE (RR: 0.52, CI: 0.28-0.94, p=0.03). Subgroup analysis for femoropopliteal disease revealed consistent benefits of IVUS guidance regarding binary restenosis (RR: 0.63, 95% CI: 0.42-0.94, p=0.03), reintervention (RR: 0.51, CI: 0.33-0.80, p=0.003), major amputation (RR: 0.85, CI: 0.73-0.99, p=0.04), death or amputation (RR: 0.68, CI: 0.51-0.90, p=0.007), and MALE (RR: 0.51, CI: 0.27-0.96, p=0.04). The sensitivity analysis of studies using drug-coated device also showed the consistent benefit of IVUS guidance regarding binary restenosis. In conclusion, compared to angiography, IVUS-guided EVT provided improved clinical outcomes in terms of binary restenosis, reintervention, major amputation, death or amputation, and MALE in lower extremity artery disease, including femoropopliteal disease.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823764","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":"Meta-analysis comparing immediate versus staged complete revascularization for ST-elevation myocardial infarction with multivessel disease.","authors":"Abdulrahman M Almizel, Jeremy Y Levett, Tetiana Zolotarova, Mark J Eisenberg","doi":"10.1016/j.amjcard.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.013","url":null,"abstract":"<p><p>Patients with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI), and the optimal timing of complete revascularization (CR) in these cases remains uncertain. This study aims to assess major adverse cardiovascular events (MACE) and procedural complications in STEMI patients with multivessel CAD undergoing immediate (index procedure) versus staged CR. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged complete revascularization (CR) in STEMI and multivessel CAD. Trials were identified via a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using RevMan software. Five RCTs (n=1,415) were included in our study, which showed no significant differences in MACE (13.3% vs. 9.8%; RR: 1.07, 95% CI [0.62, 1.83]), all-cause mortality (3% vs. 4.55%; RR: 0.70, 95% CI [0.41, 1.21]), or myocardial infarction (4.5% vs. 2.6%; RR: 1.43, 95% CI [0.58, 3.55]) at a weighted mean follow-up duration of 16 months. However, the staged group had a higher rate of unplanned revascularization (8.6% vs. 4.4%; RR: 1.92, 95% CI [1.21, 3.04]). In conclusion, in STEMI patients with multivessel CAD, at a mean follow-up of approximately 1.3 years, there is no significant difference in immediate versus staged revascularization for MACE; however, staged revascularization was associated with a significantly higher incidence of unplanned ischemia-driven revascularization. Staged revascularization within the index hospitalization may be as effective as immediate complete revascularization; further trials are needed to confirm this. CONDENSED ABSTRACT We conducted a meta-analysis of 5 randomized controlled trials comparing immediate to staged CR in STEMI patients with multivessel CAD. There was no significant difference in major adverse cardiovascular events, all-cause mortality, and myocardial infarction rates between immediate and staged complete revascularization. However, staged revascularization was associated with a higher incidence of unplanned ischemia-driven revascularization.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823697","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":"Artificial Intelligence-Driven Assessment of Coronary CT Angiography for Intermediate Stenosis: Comparison with Quantitative Coronary Angiography and Fractional Flow Reserve.","authors":"Jung In Jo, Hyun Jung Koo, Joon Won Kang, Young Hak Kim, Dong Hyun Yang","doi":"10.1016/j.amjcard.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.011","url":null,"abstract":"<p><p>We aimed to compare artificial intelligence (AI)-based coronary stenosis evaluation of coronary CT angiography (CCTA) with its quantitative counterpart of invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). This single-center retrospective study included 195 symptomatic patients (mean age 61 ± 10 years, 149 men, 585 coronary arteries) with 215 intermediate coronary lesions, with quantitative coronary angiography (QCA) diameter stenosis ranging from 20-80%. An AI-driven research prototype (AI-CCTA) was used to quantify stenosis on CCTA images. The diagnostic accuracy of AI-CCTA was assessed on a per-vessel basis using invasive coronary angiography stenosis grading (with ≥50% stenosis) or invasive FFR (≤0.80) as reference standards. AI-driven diameter stenosis was correlated with the QCA results and expert manual measurements subsequently. The disease prevalence among the 585 coronary arteries, as determined by invasive angiography (≥50%), was 46.5%. AI-CCTA exhibited a sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) of 71.7%, 89.8%, 85.9%, 78.5%, and 0.81, respectively. The diagnostic performance of AI-CCTA was moderate for the 215 intermediate lesions assessed using QCA and FFR, with an AUC of 0.63 for QCA and FFR. AI-CCTA demonstrated a moderate correlation with QCA (r=0.42, p < 0.001) for measuring the degree of stenosis, which was notably better than the results from manual quantification versus QCA (r=0.26, p=0.001). In conclusion, AI-driven CCTA analysis exhibited promising results. AI-CCTA demonstrated a moderate relationship with QCA in intermediate coronary stenosis lesions; however, its results surpassed those of manual evaluations.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821833","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":"Transient Low-Intensity Late Gadolinium Enhancement in Takotsubo Cardiomyopathy.","authors":"Haojie Wang","doi":"10.1016/j.amjcard.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.006","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821834","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":"Sex- and Age-Based Differences in Non-Syndromic Arteriopathies Amongst Younger Adults.","authors":"George Bcharah, Christine E Firth, Merna M Abdou, Srekar N Ravi, Ramzi Ibrahim, Girish Pathangey, Sant J Kumar, Mahmoud H Abdelnabi, Yuxiang Wang, Mayoma A Osundiji, Fadi E Shamoun","doi":"10.1016/j.amjcard.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.009","url":null,"abstract":"<p><p>Aneurysms are often associated with connective tissue disorders, but most occur sporadically and are non-syndromic. Manifestations of these non-syndromic arteriopathies across sexes and age groups have not been discussed extensively in the literature, especially in younger cohorts. We analyzed data from 84,496 patients in the Mayo Clinic Tapestry DNA Sequencing Study, excluding those with known vascular syndromes. Patients ≤ 60-years-old were included and grouped by sex and into five age groups (18-60). The odds and prevalence of various arteriopathies and complications (i.e. revascularization, stroke, dissection, and death) were compared. Overall, 909 patients ≤ 60 years-old were included with 68.0% females (mean age=47.49). Females were more likely to have carotid/cerebral aneurysms (55.2% vs 31.6%, p<0.0001), and males were more likely to have thoracic (50.9% vs 21.8%, p<0.0001) and abdominal aortic aneurysms (7.22% vs 2.59%, p<0.01). Males with splanchnic and carotid/cerebral aneurysms were more likely to dissect (58.14% vs 21.49% and 45.65% vs 30.79% p<0.05, respectively). Females were more likely to have multi-site aneurysms (16.34% vs 12.03%, p<0.05), with the most common being concurrent carotid/cerebral and splanchnic aneurysms. Both sexes showed peak dissection rates at ages 36-45, although males experienced more complications in older age groups (56-60) and females in younger ones (46-55). In conclusion, males are more susceptible to large vessel aneurysms and complications later in life, whereas females more frequently experience medium vessel aneurysms, complications earlier in life, and co-occurring multi-site aneurysms. Potential un-identified genetic factors could be influencing these patterns.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816979","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 multimodality imaging and special treatment considerations for pericarditis in pregnancy.","authors":"Rehan Karmali, Issam Motairek, Samia Mazumder, Felix Berglund, Lorenzo Braghieri, Astefanos Al-Dalakta, Katherine Singh, Brittany Weber, Allan Klein","doi":"10.1016/j.amjcard.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.007","url":null,"abstract":"<p><p>Pericarditis in women who are pregnant or of childbearing age poses a challenge to clinicians. Currently, there are no guidelines regarding the optimal approach for managing pericarditis in pregnancy with regards to selecting the appropriate method of diagnostic imaging or tailoring the treatment regimen to gestational age. Pericarditis in pregnancy may manifest as an autoimmune or autoinflammatory phenotype but the predominant etiology is idiopathic. Transthoracic echocardiography and cardiac magnetic resonance are considered safe, but data is lacking on the use of gadolinium-based contrast agents. Shared-decision making is paramount to balance risks and benefits of radiation and contrast exposure to the mother and fetus. The safety profile of treatment options differs at each time-interval from preconception to the three trimesters and postpartum phase. A multidisciplinary approach using imaging guidance can improve outcomes in pregnant patients with pericarditis. Further studies are needed to ascertain the safety of Interleukin-1 blocking agents in pregnancy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816977","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":"Coronary Artery Dissection in Drug-Coated Balloon Angioplasty: Incidence, Predictors, and Clinical Outcomes.","authors":"Mauro Gitto, Pier Pasquale Leone, Francesco Gioia, Mauro Chiarito, Alessia Latini, Francesco Tartaglia, Ismail Dogu Kilic, Marco Luciano Rossi, Damiano Regazzoli, Gabriele Gasparini, Ottavia Cozzi, Alessandro Sticchi, Gianluigi Condorelli, Bernhard Reimers, Giulio Giuseppe Stefanini, Antonio Mangieri, Antonio Colombo","doi":"10.1016/j.amjcard.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.008","url":null,"abstract":"<p><p>Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCB) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. The aim of this study was to evaluate incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease (CAD). Consecutive patients with de novo CAD undergoing PCI with intention-to-treat DCB angioplasty, with or without stent implantation, were retrospectively enrolled between 2018 and 2022 at two Italian centers. The decision whether to leave a dissection untreated or to proceed with bail-out stenting was based on a combined angiographic evaluation of Thrombolysis In Myocardial Infarction flow, residual minimal lumen diameter and persistent extra-luminal contrast hang-up. The primary endpoint at 2-year follow-up was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularization. Among 522 DCB-treated lesions in 466 patients, dissections were angiographically evident in 39.1% of lesions, with 21.1% undergoing bail-out stenting and 78.9% left untreated. Incidence of bail-out stenting increased from type A to type E dissections (p for trend <0.001). Left anterior descending artery involvement (OR 1.64, 95% CI: 1.12-2.39) was the strongest risk factors for dissection. TLF at 2-year occurred in 2.7% of lesions with untreated dissection compared to 4.2% of those with no dissection (log-Rank p =0.324). In conclusion, coronary dissections often complicate PCI with DCB angioplasty but do not correlate with increased risk of adverse events at mid-term follow-up.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816975","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":"Type A Aortic Dissection After TEVAR for Type B.","authors":"Kyle A McCullough, Katherine R Hebeler, John B Eisenga, Baron L Hamman, Charles S Roberts","doi":"10.1016/j.amjcard.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.005","url":null,"abstract":"<p><p>Type A aortic dissection (TAAD) has been associated with thoracic endovascular aortic repair (TEVAR) for aortic conditions, both dissection and aneurysm. Our purpose was to study a subset of patients who had an initial TEVAR for type B aortic dissection, followed later by a TAAD which was treated by open ascending aortic repair. Over a 6-year period, 171 consecutive patients underwent open ascending aortic repair for TAAD, of whom 21 (12%) had a previous cardiovascular procedure, 17 of which were endovascular. Nine (5.2%) of the total 171 TAAD patients had a prior TEVAR for a type B. The mean interval from TEVAR to open ascending aortic repair for TAAD was 4.6 years, with only 1 occurring within a month. Only one patient had abnormal aortic media by histology. In 5 of the 9 patients, the entry tear was in the proximal ascending aorta, remote from the endograft, which suggests that a TAAD late after TEVAR for type B represents a new spontaneous event.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811697","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":"Early and Long-term Outcomes of Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention to the Left Main Coronary Artery.","authors":"Mohammad Abdelghani, Salma Taha, Osama Shoeib, Kevin Hamzaraj, Amr Y Emam, Khaled M Elmaghraby, Mohamed Elsoudi, Mahmoud Abdelshafy, Robbert J de Winter, Ahmed Elguindy, Rayyan Hemetsberger, Ahmed Hassan","doi":"10.1016/j.amjcard.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.amjcard.2024.12.001","url":null,"abstract":"<p><p>Patients undergoing percutaneous coronary intervention (PCI) to the left main (LM) coronary artery in the setting of acute coronary syndrome (ACS) were not adequately studied in the era of modern PCI. We investigated early and long-term outcomes of these patients, especially those with a true LM bifurcation stenosis. The Left Main Intervention in Acute Coronary Syndrome (LIMACS) is a multicenter registry that enrolled patients undergoing PCI to unprotected LM disease in the setting of ACS using a drug-eluting stent. The study included 360 patients (age, 65±12 years; male, 74%; STEMI, 65%). During index hospitalization, 25% of patients developed cardiogenic shock and 15% died. Cardiogenic shock (adjOR[95% CI]: 26[7-93]) and final TIMI grade <3 flow (adjOR[95% CI]: 7[1.6-31]) were associated with in-hospital mortality. Three-year mortality (37%) correlated with left ventricular ejection fraction≤40% (adjHR: 2.4[1.4-4.2]), Killip class II-IV at presentation (adjHR: 1.7[1.02-2.8]), LM culprit (adjHR: 1.7[1.04-2.8]), true LM bifurcation stenosis (adjHR: 1.8[1.1-2.9]), final TIMI grade <3 flow (adjHR: 3.2[1.7-5.8]), and radial access (adjHR: 0.58[0.38-0.99]). In patients with true LM bifurcation stenosis (n=127), two-stent strategy was adopted in 60% and was associated with lower 3-year mortality or repeat revascularization compared with one-stent strategy (48% vs. 69%, p=0.012). In conclusion, patients undergoing PCI to the LM in the setting of an ACS sustain high adverse event rates. Hemodynamic status, LM culprit lesion, femoral access, and failure to restore normal flow are major determinants of adverse outcomes. In patients with LM true bifurcation lesions, outcomes are impaired especially with one-stent strategy. Study Registration: ClinicalTrials.gov ID: NCT05701319.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799019","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}