American Journal of Cardiology最新文献

{"title":"Angiographic No-Reflow in Patients With Acute Coronary Syndrome Caused by Calcified Nodules.","authors":"Yuichi Ozaki, Hironori Kitabata, Ryo Hikida, Yuta Takano, Yosuke Katayama, Masahiro Takahata, Teruaki Wada, Akira Taruya, Manabu Kashiwagi, Yasutsugu Shiono, Akio Kuroi, Takashi Tanimoto, Takashi Yamano, Atsushi Tanaka","doi":"10.1016/j.amjcard.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.008","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) caused by calcified nodules (CNs) has a poor prognosis. The no-reflow phenomenon in CNs has not been well studied. We investigated the incidence of the no-reflow phenomenon, evaluated the relationship between the no-reflow phenomenon and plaque components in patients with ACS caused by CNs, and compared the clinical outcomes on the basis of plaque morphology and components. This study enrolled 355 ACS patients who had de novo culprit lesions in a native coronary artery. The culprit lesions were assessed by both optical coherence tomography (OCT) and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). The patients were classified into 3 groups according to OCT findings (plaque rupture [PR], plaque erosion [PE], or CN), and then respectively divided into 2 groups using a maximum lipid core burden index in 4 mm (maxLCBI_4mm) cutoff value of 400 on NIRS-IVUS. The maxLCBI_4mm in the infarct-related lesion was greater in patients with PR (641 [461-772]) than in those with PE (vs. 533 [373-713], p=0.004) and CN (vs. 479 [342-639], p=0.002). In patients with CN, the maxLCBI_4mm was significantly greater in patients with the no-reflow phenomenon than in those without (p=0.027). The incidence of major adverse cardiovascular events was significantly higher in patients with CN and a maxLCBI_4mm ≥400 than in those with other plaque features (p=0.024). Underlying lipidic components are associated with the no-reflow phenomenon in CNs. CNs and a large lipid core provide worse long-term clinical outcomes after percutaneous coronary intervention in ACS.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245927","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":"Impact of Bifurcation Angle on Side Branch Occlusion in Provisional Bifurcation Percutaneous Coronary Intervention: Analysis from the PROGRESS-BIFURCATION Registry.","authors":"Deniz Mutlu, Ozgur Selim Ser, Dimitrios Strepkos, Pedro E P Carvalho, Michaella Alexandrou, Barkin Kultursay, Ali Karagoz, Oleg Krestyaninov, Dmitrii Khelimskii, Mahmut Uluganyan, Korhan Soylu, Ufuk Yildirim, Mehmet Semih Belpinar, Olga Mastrodemos, Bavana V Rangan, Jaskanwal Deep Singh Sara, Sandeep Jalli, Konstantinos Voudris, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis","doi":"10.1016/j.amjcard.2025.05.033","DOIUrl":"10.1016/j.amjcard.2025.05.033","url":null,"abstract":"<p><p>Limited information exists on the impact of the bifurcation angle on side branch occlusion (SBO) in provisional percutaneous coronary intervention (PCI) techniques and outcomes. We examined the procedural characteristics and outcomes of 1015 bifurcation PCIs (855 patients) that were performed using the provisional technique between 2014 and 2023 from a multicenter bifurcation PCI registry (NCT05100992). The median bifurcation angle was 60° (interquartile range [IQR] 40°-80°). Patients were divided into 3 groups: narrow angle (<45°), middle angle (45-70°), and wide angle (>70°). Patients in all groups had similar baseline clinical characteristics. Lesions in the wide-angle group had larger proximal and distal main vessel and side branch diameter. Technical and procedural success and in-hospital major adverse cardiovascular events (MACE) were similar in all groups. Overall SBO was 14.6% and was more likely to be observed in the narrow angle group (22.6%) than the remaining groups (middle angle 11.7%, wide angle 12.8%, p <0.001). In multiple logistic regression analysis, wider bifurcation angle was associated with lower risk of SBO (adjusted odds ratio [aOR] per 10-degree increments: 0.88 [95% confidence interval (CI), 0.80 to 0.98; p = 0.017]). A U-shaped association was seen between bifurcation angle and SBO, where restricted cubic spline analysis demonstrated that the lowest risk of SBO was at a bifurcation angle of 100° (aOR 0.19, 95% CI 0.07 to 0.55, p = 0.002). In patients undergoing provisional stenting, narrow bifurcation angle was associated with higher SBO risk.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245930","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":"Clinical Outcomes of Intravenous Iron Therapy in Systolic Heart Failure Patients Receiving SGLT2 Inhibitors.","authors":"Waleed Alruwaili, Syed Ahmed, Seher Berzingi, Lalitsiri Atti, Amro Taha, Sittinun Thangjui, Harshith Thyagaturu, Sudarshan Balla","doi":"10.1016/j.amjcard.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.006","url":null,"abstract":"<p><p>SGLT2 inhibitors (SGLT2i) can mimic iron deficiency (ID) by altering iron biomarkers. Although intravenous (IV) iron therapy is an established treatment for ID in HF, it remains unclear whether concomitant use of IV iron and SGLT2i increases the risk of thromboembolic events (TE). We aim to evaluate the risks associated with combined IV iron therapy and SGLT2i in patients with systolic HF and ID. Using the TriNetX database, we identified patients with systolic HF on SGLT2i at baseline with a diagnosis of ID (serum ferritin <100 μg/L). Patients were stratified by IV iron therapy use. Propensity score matching was used to balance confounding factors between groups. Cox Proportional Hazard ratio was calculated for TE, all-cause mortality, major adverse cardiovascular events (MACE), and HF exacerbation over a 1-year follow-up. Of 14,863 patients, 2,908 (19.5%) received IV iron therapy. The mean age in the treatment group and the control group was 66.8 years (54.5% male) and 67.2 years (54.7% male), respectively. IV iron treatment was associated with significantly increased risks of TE (HR: 1.38; 95% CI: 1.02-1.87; p = 0.032), MACE (HR: 1.26; 95% CI: 1.05-1.51; p = 0.010), all-cause mortality (HR: 1.45; 95% CI: 1.25-1.67; p < 0.001), and HF exacerbation (HR: 1.65; 95% CI: 1.27-2.13; p < 0.001). Patients with systolic HF and ID receiving combined IV iron therapy and SGLT2 inhibitors had significantly increased risks of TE, MACE, all-cause mortality, and HF exacerbations. Further mechanistic studies are required to elucidate the interactions between IV iron and SGLT2i.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245928","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":"Transcatheter Aortic Valve Replacement for Patients with Moderate Aortic Stenosis - a Propensity Matched Analysis: TAVR vs clinical surveillance for moderate AS.","authors":"Rik Adrichem, Cindy Yang, Marcel L Geleijnse, Mark M P van den Dorpel, Paul A Cummins, Isabella Kardys, Joost Daemen, Rutger-Jan Nuis, Nicolas M Van Mieghem","doi":"10.1016/j.amjcard.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.032","url":null,"abstract":"<p><p>Moderate aortic stenosis (AS) has been linked to impaired long-term survival. Whether transcatheter aortic valve replacement (TAVR) may improve clinical outcome of moderate AS is unknown. We aimed to investigate the potential clinical benefits of TAVR for patients with moderate AS irrespective of LVEF. We used univariable and multivariable Cox regression models to find predictors for mortality and a composite of mortality and heart failure hospitalizations. We also performed a propensity score-matched comparison of outcomes between patients with moderate AS who underwent TAVR, and those with clinical surveillance with surgical aortic valve replacement or TAVR only upon progression to severe AS. We identified 115 patients with moderate AS who underwent TAVR and 220 patients with moderate AS who underwent clinical surveillance. TAVR patients were older, had more comorbidities and were more symptomatic than the clinical surveillance patients. TAVR was associated with lower all-cause mortality (multivariable adjusted HR: 0.51, 95%CI: 0.35-0.76) and reduced incidence of the composite endpoint of all-cause mortality and heart failure hospitalizations (adjusted HR: 0.53, 95%CI: 0.36-0.77). These results were reinforced in our propensity score matched analysis (unadjusted matched HR: 0.50, 95% CI: 0.33-0.75). In conclusion, TAVR may improve clinical outcome in patients with moderate AS. Our findings justify randomized controlled trials that evaluate TAVR in patients with moderate AS.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245943","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":"Remodeling and reverse-remodeling of left atrium and appendage after catheter ablation for atrial fibrillation.","authors":"Tetsuma Kawaji, Takanori Aizawa, Issei Seto, Saki Yamano, Misaki Naka, Bingyuan Bao, Shun Hojo, Shintaro Matsuda, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1016/j.amjcard.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.001","url":null,"abstract":"<p><p>The processes of remodeling and reverse-remodeling of left atrial (LA) and LA appendage (LAA) after catheter ablation for atrial fibrillation (AF) are insufficiently evaluated. A total of 372 consecutive AF patients undergoing ablation procedure with contrast CT images and whose follow-up CT images were acquired after the procedure were enrolled. From those CT images, LA volume (LAV), LA emptying fraction (LAEF), LAA volume (LAAV), and LAAEF were measured. Mean age of patients was 70 years, and CHA₂DS₂-VASc score was 2.5±1.7. Mean LAV, LAEF, LAAV, and LAAEF were 121.3 ml, 22.1%, 18.6 ml, and 23.5%, respectively. For patients with LA and LAA remodeling, non-paroxysmal AF (non-PAF) was more prevalent and strongly correlated with heart failure-related parameters. All types of remodeling were associated with recurrent post-procedure atrial tachyarrhythmias, and LAV emerged as an independent risk factor for recurrent tachyarrhythmias (adjusted hazard ratio 1.01, P=0.02) in multivariable analysis. Follow-up CT images showed that LAV and LAAV significantly decreased, while LAEF and LAAEF significantly increased accompanied by a reduction in filling defects in the LAA. After the procedure, reverse-remodeling was prominent in non-PAF patients, while LAEF significantly decreased in PAF patients. The decrease in LAEF for PAF patients was significantly larger in those who received additional ablation beyond pulmonary vein isolation (PVI) than those who received PVI alone. On the other hand, in non-PAF patients, post-procedure LA reverse-remodeling was consistent regardless of ablation strategy, but significantly poor in those with recurrence. In conclusions, LA and LAA remodeling were more prevalent in non-PAF patients. LA and LAA reverse-remodeling after the ablation procedure were remarkable in non-PAF patients, especially those without recurrence. Meanwhile, LAEF decreased after the procedure in PAF patients, particularly in those who received additional ablation beyond PVI.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245932","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":"Proton Pump Inhibitor Use, Gastrointestinal Bleeding Reduction, and Long-Term Prognosis After Percutaneous Coronary Intervention.","authors":"Tatsuya Tokai, Masanobu Ishii, Yasuhiro Otsuka, So Ikebe, Taishi Nakamura, Kenichi Tsujita, Naoyuki Akashi, Hideo Fujita, Yasuhiro Nakano, Tetsuya Matoba, Takahide Kohro, Yusuke Oba, Tomoyuki Kabutoya, Kazuomi Kario, Yasushi Imai, Arihiro Kiyosue, Yoshiko Mizuno, Kotaro Nochioka, Masaharu Nakayama, Takamasa Iwai, Yoshihiro Miyamoto, Hisahiko Sato, Ryozo Nagai","doi":"10.1016/j.amjcard.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.037","url":null,"abstract":"<p><p>Proton pump inhibitors (PPI) reduce gastrointestinal bleeding (GIB) after percutaneous coronary intervention (PCI), but their impact on mortality and major adverse cardiovascular events (MACE) remains unclear. This study investigated the association between PPI-related GIB reduction and MACE and mortality using a real-world database. We analyzed 6,457 patients undergoing PCI (2013-2019), using the Clinical Deep Data Accumulation System including electronic medical records from seven Japanese hospitals. Patients were grouped by PPI use. The primary outcome was GIB and secondary outcomes were all-cause mortality and MACE. Propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and Cox regression were used to estimate hazard ratios. To estimate causal inference, mediation analysis was conducted to assess the indirect effects of PPI use via GIB reduction. PSM and IPTW analyses revealed a lower GIB incidence in the PPI group (PSM: <0.1%, IPTW: 1.6%) than in the non-PPI group (PSM: 2.3%, IPTW: 2.7%). No significant association was found between PPI use and all-cause death or MACE. However, in patients with acute coronary syndrome (ACS), IPTW analysis indicated that PPI use was associated with lower all-cause death (HR: 0.582, 95% CI: 0.364-0.931) and MACE (HR: 0.570, 95% CI: 0.344-0.946). Importantly, mediation analysis suggested that GIB reduction partially mediated the association between PPI use and lower mortality. In conclusion, PPI use after PCI was associated with lower GIB risk. In ACS patients, it may be associated with a reduction in all-cause mortality, partially mediated by GIB reduction.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245931","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":"Drug-Coated Balloon Versus Newer-Generation Drug-Eluting Stent Following Directional Coronary Atherectomy for Left Main Bifurcation Lesions.","authors":"Kota Murai, Kensuke Takagi, Fumiyuki Otsuka, Yoshiyuki Tomishima, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kazuhiro Nakao, Yu Kataoka, Yasuhide Asaumi, Kisaki Amemiya, Manabu Matsumoto, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Kinta Hatakeyama, Teruo Noguchi","doi":"10.1016/j.amjcard.2025.05.036","DOIUrl":"10.1016/j.amjcard.2025.05.036","url":null,"abstract":"<p><p>Directional Coronary Atherectomy (DCA) is a potential treatment option for left main (LM) bifurcation lesions, as it may prevent side branch occlusion and reduce the need for complex stenting. Recent studies have suggested that combining drug-coated balloon (DCB) with DCA can lead to favorable cardiovascular outcomes. However, the comparative efficacy of DCB and current drug-eluting stents (DES) following DCA for LM bifurcation lesions remains unclear. This study aimed to compare the clinical outcomes of DCB and DES following DCA for LM bifurcation lesions. A retrospective analysis was conducted on 109 patients treated with DCA for LM bifurcation lesions from 2016 to 2024. Patients were divided into groups of DCA+DCB (n = 58) and DCA+DES (n = 51). The primary endpoint was ischemia-driven target lesion revascularization (ID-TLR), and the secondary endpoint was target lesion-related myocardial infarction (TLMI). Lesion characteristics were evaluated using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). Kaplan-Meier analysis revealed higher ID-TLR occurrence at 5 years in the DCA+DCB group than the DCA+DES group (16.4% vs 2.3%, P = 0.027). In contrast, TLMI occurrence was similar (4.7% vs 2.3%, p = 0.667). The DCA+DCB group exhibited greater residual diameter stenosis (24.4% vs 16.3%, p <0.001) on QCA and smaller minimum lumen area (7.33 mm² vs 8.42 mm², p <0.001) and greater residual plaque area (48.9% vs 45.3%, p = 0.027) on intravascular ultrasound (IVUS) compared to the DCA+DES group. In conclusion, the DCA+DCB strategy was associated with a higher ID-TLR incidence and a smaller luminal gain than DCA+DES. Although DCA+DCB provides a stent-less alternative, long-term monitoring is essential to address its limitations.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245929","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":"Real-World Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal for Infected Cardiac Implantable Electronic Devices in the United States.","authors":"Siddharth Agarwal, Harsh P Patel, Zain Ul Abideen Asad, Muhammad Bilal Munir, Alan Sugrue, Nicholas Y Tan, Freddy Del-Carpio Munoz, Deepak Padmanabhan, Daniel DeSimone, Siva K Mulpuru, Yong-Mei Cha, Christopher V DeSimone, Danesh K Kella, Abhishek Deshmukh","doi":"10.1016/j.amjcard.2025.05.035","DOIUrl":"10.1016/j.amjcard.2025.05.035","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232992","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":"Computed Tomography Scan Predictors and Prognostic Impact of Combined Pulmonary Hypertension in Patients With Aortic Valve Stenosis undergoing TAVI.","authors":"Francesco Putortì, Tommaso Fabris, Michele Strosio, Consolato Mesiani, Antonio Amadio, Simone Tripi, Andrea Panza, Federico Arturi, Samiha Tamanna, Luca Nai Fovino, Francesco Cardaioli, Giulia Masiero, Chiara Fraccaro, Massimo Napodano, Giuseppe Tarantini","doi":"10.1016/j.amjcard.2025.05.034","DOIUrl":"10.1016/j.amjcard.2025.05.034","url":null,"abstract":"<p><p>Precapillary (PrPH) and combined pre and postcapillary pulmonary hypertension (CoPH) increase all-cause and cardiovascular mortality risk in patients undergoing TAVI for severe symptomatic aortic stenosis. Since pulmonary artery (PA) diameter adapts to increased pulmonary artery pressure, this study evaluates the correlation between CT-derived main PA (MPA), right PA (RPA), left PA (LPA) diameters, and the MPA/ascending aorta (AA) ratio with PH subtypes defined by right heart catheterization (RHC), as well as their prognostic impact. This retrospective study includes all consecutive patients undergoing TAVR between June 2007 to December 2022 with pre-TAVI RHC and ECG-gated CT scans. The primary endpoint was all-cause mortality. Mean follow-up time was 5 years. Among 638 consecutive patients, 329 (51%) had normal mPAP, while 309 (49%) had PH. Of these, 143 (46%) had isolated postcapillary PH (IpcPH), and 166 (54%) had CoPH. Patients with PrPH were excluded. CoPH patients had higher PAP than both IpcPH and no-PH groups. In univariable and multivariable analysis, MPA, MPA index (MPAi), RPA, RPA index (RPAi), MPA/AA, MPAi/AA, and RPA/LPA correlated with PH, while MPA, MPAi, RPA, RPAi, MPA/AA, and MPAi/AA were associated with CoPH. The best AUC for PH discrimination was MPAi (AUC = 0.71, cutoff = 16 mm/m², sensitivity = 66%, specificity = 72%), while MPA/AA best discriminated CoPH (AUC = 0.73, cutoff = 0.88, sensitivity = 67%, specificity = 72%). Patients with PA/AA <0.88 had significantly lower 5-year mortality after TAVI than those with PA/AA ≥0.88 (log-rank p = 0.046, HR 1.39). In conclusion, Increase in MPA/AA CT-derived ratio is predictive of Combined PH, highlighting patients who could benefit from a RHC in term of CV stratification before TAVI.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232991","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":"Bridging Gaps in LDL-C Management: Utilization of Lipid-Lowering Therapies, Gender Disparities, and the Impact of Cardiology Visits on Secondary Prevention.","authors":"Surik Sedrakyan, Bilawal Nadeem, Diane Gaughran, Ana Sinauridze, Ann Georgy, Hurley Sally, Uyen Lam","doi":"10.1016/j.amjcard.2025.05.029","DOIUrl":"10.1016/j.amjcard.2025.05.029","url":null,"abstract":"<p><p>Effective lipid control is essential for secondary cardiovascular prevention, with an LDL-C target of <70 mg/dL recommended for high-risk patients. While novel lipid-lowering therapies have expanded treatment options, their real-world use and impact on LDL-C control remain uncertain. This retrospective cohort study included 19,108 patients with coronary artery disease across 7 hospitals in Massachusetts from January 2019 to March 2024. We evaluated the use of novel therapies, sex disparities in LDL-C goal attainment, and the influence of outpatient cardiology care and cardiac rehabilitation. Categorical associations were analyzed using chi-square tests, and multivariable logistic regression was conducted to account for confounding variables. In the final cohort, only 50.1% achieved LDL-C <70 mg/dL. Most (74.9%) were on monotherapy, among whom 53.1% met the target. Dual therapy use was low (12.2%). Females were less likely to meet LDL-C goals (OR 0.53, 95% CI 0.49 to 0.58), had higher mean LDL-C (76.9 vs 67.7 mg/dL; p <0.001), and were less likely to be on combination therapy (OR 0.77, 95% CI 0.68 to 0.86). Cardiology visits improved LDL-C goal attainment (OR 1.54, 95% CI 1.41 to 1.67), and cardiac rehabilitation significantly lowered LDL-C (from 89.1-66.1 mg/dL; p <0.001). In conclusion, despite expanded therapeutic options, many patients fail to achieve LDL-C targets, reflecting underutilization of available treatments. Specialist care and cardiac rehabilitation were associated with improved lipid control, but persistent disparities in women highlight the need for more equitable implementation of guideline-based care.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224043","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}